by Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA
.
….or to be more specific, HITECH is synergistic with payment reform that could come from the recently passed national health care reform legislation — the Patient Protection and Affordable Care Act (PPACA).
We’ll keep this post fairly short and try to avoid many of the more divisive aspects of this topic. The need for healthcare payment reform is well understood on both sides of the aisle:
Realizing the full potential of health IT depends in no small measure on changing the health care system’s overall payment incentives so that providers benefit from improving the quality and efficiency of the services they provide. Only then will they be motivated to take full advantage of the power of electronic health records. Dr. David Blumenthal, New England Journal of Medicine, April 9, 2009
What’s the Connection Between Health IT and Payment Reform?
A lot has already been written about the problems with payment approaches in health care. The current system rewards piecemeal work, thus economically incentivizing care providers to deliver more visits, tests, admissions, etc.
Todd Park and Peter Basch describe the dynamics between payment and health IT in their 2009 report: A Historic Opportunity: Wedding Health Information Technology to Care Delivery Innovation and Provider Payment Reform. They describe an interconnected “vicious cycle” among: lack of provider payment reform, lack of care delivery innovation, and lack of health IT adoption. They also describe a “virtuous cycle” among: provider payment reform, care delivery innovation, and health IT adoption.
(click on a graphic to see a larger version)
Basch and Park suggest some of the innovations that could be powered by health IT:
- Preventive care
- Chronic disease management
- Care coordination
- Non-visit-based care, or “e-care”
- Knowledge-based medication management
The PPACA also legislates many innovative initiatives that are highly dependent on health IT for success. Examples include quality reporting, administrative simplification, a medical device registry, etc. A recent HIMSS analysis provides a detailed (176 pages!) list and description of Health IT Provisions in the PPACA [membership required].
What Payment Reforms are Contemplated by the PPACA?
The PPACA does not directly change payment systems for health care providers.
The PPACA authorizes extensive demonstration and pilot projects to test various models of care delivery and payment reform, e.g., Accountable Care Organizations, Patient Centered Medical Homes, bundled payments, etc. The PPACA also creates the Center for Medicare and Medicaid Innovation and provides it with independent authority to conduct additional pilots.
Few details are available…and this will take several years to play out…
…yet we are very hopeful that HITECH and forthcoming payment reforms will be able to create the Virtuous Cycle. Stay tuned.
Article Series - Is HITECH Working?
- Is HITECH Working? 7 Observations Mom Could Understand
- Is HITECH Working? #1: Hospitals are grumbling but are playing in the game; success is not guaranteed.
- Is HITECH Working? #2: Key physicians will sit on the sidelines (at least for now).
- Is HITECH Working? #3: ONC got it right on the 3 major policy interpretations: Meaningful Use, Certification, Standards
- Is HITECH Working? #4: While most attention has been focused on demand side incentives (will doctors and hospitals buy EHRs?), the supply (vendor) side of HIT is already transforming.
- Is HITECH Working? #5: “Gimme my damn data!” The stage is being set to enable patient-driven disruptive innovation.
- Is HITECH Working? #6: HITECH and Health Reform Objectives are Synergistic
- Is HITECH Working? #7: Where’s Plan B? Congress and ONC need to address major flaws in HITECH.
Vince, this is one of the best article I have read. Dr. David Blumenthal is a true visionary leader.
I have forseen the virtuous cycle 4 years ago and took the entreprenuer route with MD24 House Call Physicians Network. We have finally completed our MD24 platform with proven model, customized with web-based processes for House Call/Home Care then integrate with the VISTA Platform at a conservative cost. Next, we are testing our own web-base PHR and telemedicine interfacing with the VISTA Platform/CPRS. We have successfully launched the VISTA/CPRS in 40+ long term care facilities with our own 9 physicians, performing house call throughout Phoenix Metro. We proudly state that even a small company like us can still leverage the open-source Vista to provide the best quality of care virtually, reaping the incentives from HITECH in addition to a profitable House-Call Business. Supported by the City of Surprise in Ariozna and Arizona State University SkySong, we are also selected by American College of Physicians Executives for sharing MD24’s story. Again, all of these accomplishments were done through VISTA Platform. We have fortunately used a free customizable open-source stable VISTA for our virtual physicians, therefore save our money and provide the best quality of care for our own patients!!!!!!!!!!!!!! We think about the values of our patients first, not trying to pay certification/outrageous software, then working on having enough data to share better outcome with the American College of Physicians Executives. Linh C. Nguyen, MD, MS, MMM