How Will the Coming Election Year Impact Healthcare IT?

Good post John,
I think meaningful use is dead with or without anyone’s intervention. I’m glad that some want to put the nail in now before more damage to the provider community occurs. ONC and CMS has alienated and disenfranchised 100’s of thousands of providers. Penalties and forced regulation never ever works. I’ve been around long enough to see many different programs come and go. Without a doubt, MU is dead. The question is how do we get health IT back on track. It seems that ONC has no idea on how to do this. They would rather keep piling on Stage 3 measures/objectives to the 10% remaining providers that are trying to do MU. They don’t seem to get it that you need an ecosystem of all healthcare providers to make this thing work. Somehow they feel more 1000 page complicated regulation is the answer. Its kind of sad that they do not listen to the front line providers out here. If you look at regulations.gov at the stage 3 meaningful use comments that have arrived since October (the new comment period, sort them to most recent), they are 100% all negative and disturbingly similar that EHRs are in the way, unsafe, not usable, inefficient. I’m not sure what planet ONC or CMS is on, that they think that piling on with Stage 3 is even an acceptable idea at this point.
As for value based care or shared savings, this is nothing more than the same stuff tried many different ways in the past. Similar to HMOs etc. That you get one fee, and try to make the patient use as little healthcare as possible. It just does not work. Look at the pioneer ACO models, over half of the providers orgs have quit. Prominent ones. I’m not saying its not a good idea to try, but truthfully, it just does not work well. Everyone is looking for that magic pill, but its just not there. You need a vibrant working Health IT system to get this better. You actually need EHR vendors to work with providers on what they need. Not what ONC and CMS and MU wants. ONC and CMS should be working towards one thing, interoperability. Stop worrying about certification, MU, counting this and that. Its just not necessary. Let us customize our workflows, and we get our information to an HIE or whatever we all decide is the best place to share information. To accept that over hundreds of thousands of providers are not participating in health IT and MU should be a huge wake up call to anyone that wants to do VBC or ACO or CCM (chronic care management). There are just no providers left that want to take all this on…all this data entry, attestation, audit risks, counting measures and numbers, etc. We just have more important things to do. Or worse they are driving people out of practicing or participating in medicare or these programs. Penalizing providers and then putting us out of the ecosystem really devalues our work. Many of us want to participate in some important way, but just cannot risk the costs, complexity, inefficiency, auditing, 100% or none method they have set up with certified only EHRs. Its actually a much bigger mess that they even realize.

Hi John,

I agree with Meltoots. I, too, have been around this game for a few decades (hard to admit, but true!) and MU as it currently exists is toast for all the reasons Mel said. As for value-based bundled payments based on outcomes, they’ve been doing it in hospitals under DRGs for decades (even longer than I’ve been writing about it – haha!) and it can work there because the hospital controls the whole process end-to-end. When you start smooshing together different kinds of providers in different scenarios, not having a good way for them to communicate with each other, and having significant players not part of the package – eye, teeth, psych – those ACOs are going to tank. I haven’t at all been surprised that the Pioneer ACOs are leaving the wagon train. Nobody can afford to do it that way. You can’t predict without good data, and you can’t control without having all the players under your roof. So, enough about that.

As for what will or should happen with Health IT – well the government is trying to rally what they’ve got and refocus. They have a new strategic plan and a bunch of pieces that look like they make sense. I haven’t taken a close look at it, although it’s on my agenda to do so at some point and then I’ll blog about it.

As for presidential politics, yes, the guy in the White House can have an impact but healthcare has been on the same trajectory through about five administrations on both sides of the aisle, so the party is only about the tweaks and the pace. Bush gave us ONC and a great first chief in David Brailer, but has the ONC outlived its usefulness? I am inclined to think that it can play an important role under any administration. Just my paltry two cents.

For now, yes, Meltoots, I agree with what you said. And John, this is a great post and this is a terrific venue to meet up with people with like concerns. Thank you for your dedication to the task. You provide a very valuable service!

Best,
Peggy