This is not a political blog. Certainly we could explore the political ramifications, and there are very definitely some political activities that would help or hurt to varying degrees, including getting active with your Medical Association, finding out what current legislation is and how it will affect you, and then speaking with your legislators about your concerns or support. But except for the rare instance where I believe those can have a very specific outcome that affects technology in Healthcare and how individuals are adopting tech in their daily practice, I won’t delve too deeply into the political.
There is a very broad term being used in business, and in Healthcare, called “IT”. Short, obviously for Information Technology. IT has been used as a catch all for anything that plugs in or has a chip, or is a computer, or, for most people, is in any way baffling. Very intelligent and educated professionals will nod a head and murmur an indication of clear understanding of an IT topic but in reality, it’s uncommon for those outside the IT ranks to understand what is actually at stake. It’s even uncommon for those within the industry to understand what is at stake. What is at stake? What have the kids over in Silicon Valley dreamt up for us to bash our heads against? What have the all-knowing government agencies imagined is the new best way to solve the healthcare crisis, and how do the two mix? How can we imagine and then, most importantly, implement solutions to problems someone else has created?
Take, as a very simplified example, Meaningful Use. Called Meaningless Use by many, the ridiculous set of measures dreamt up by the Center for Medicare Services has been the bane of every clinical administrator for the past five to seven years, and by all accounts is about to undergo a significant shift, but without the rebates originally offered.
If you’ll recall, back in 2009, with the enactment of the HiTech act, CMS offered providers up to $44,000 in rebates for their Medicare practice, OR up to $65,000 in rebates if they were a Medicaid practitioner. The Medicaid measures were somewhat easier to implement, particularly initially, but both required an investment in and effort spent on an Electronic Health Record, or EHR. We’ve been beat over the head with MU, EHR, EMR, HIE, PQRS, and a great many other very important acronyms. The promise of a rebate was a tempting carrot for healthcare providers around the country to adopt EHR. A practice of ten providers could see almost half a million dollars in money back from the least favorite of all payors, Medicare. Who wouldn’t be interested? Unfortunately, practices quickly learned the reality was that for half a million in rebates, a million dollars in changes would need to be made, and while you experienced death by a thousand papercuts from turning the pages of the MU rulebook, the insult added to the injury was the realization that reimbursements were or were going to be cut across the board. Following this was a higher cost of doing business, higher UNPAID patient deductibles, and lower overall reimbursement. Add a new 5010 claim form with mountains of adoption problems, long overdue implementation of ICD10, constant retroactive changes to MU regulations (imagine the effects on the EHR vendors, who had to jump through every hoop with no input as to the mechanisms in which they were supposed to be incorporated!!) and you can see very quickly why providers and administrators have been overwhelmed.
I don’t think anyone is arguing against the overwhelming need for reform in the payment AND DELIVERY methods of modern healthcare in the United States. Our per capita spending on healthcare is the highest in the world, although to be fair, our per capita spending on just about every luxury or consumable is the highest in the world. It’s an American lifestyle requirement, and not one that’s likely to be reversed in the near future. What are distinctly un-American are the results we are seeing. Pareto’s principle has never been more perfectly illustrated. 80% of the cost of American healthcare is spent on 20% of the population.
What to do? Before we can make this about politics, about pride, about population health management, we must be able to measure and CHANGE healthcare outcomes. Who is best suited to do this? The government? The President? Your Congressmen and women in state and federal capacities? Judges? Clearly not.
Healthcare professionals are the ONLY people that can make these changes effectively. Some have taken up the mantle. Dr. Zubin Damania has done some amazing work in Las Vegas. Known on social media as ZDoggMD, he has a Youtube channel with tens of thousands of followers, and he has some amazing and creative songs and videos that are guaranteed to make you laugh. But did you also know that he is LIVING the experiment? He has opened a community health practice in Las Vegas, and is bucking traditional wisdom and finding ways to help patients and people. I hope to feature his work in a future article or intyerview, or both.
So. How can technology be used in Healthcare? What if we ask this instead: How can we effectively, valuably, measurably implement technology to positive effect in a small practice? How can one doctor, or a group of ten doctors, or even 50; how can they make meaningful, efficient use of technology in such a way that they NOTICE that technology is making life better and not just costing them money?
Share your thoughts, criticisms, and overall opinion below!