will evidence-based medicine shift hospitals to accountable-care organizations?

from http://www.dallasnews.com/sharedcontent/dws/bus/stories/112909dnbusbaylor.3d5ccc5.html

In an accountable-care organization, doctors and hospitals share a financial incentive to control costs and improve quality by coordinating care for a defined patient group.

Today, most medical care in Dallas and across the nation is delivered piecemeal. Doctors are paid for each patient visit. Hospitals are paid for each procedure. This “fee-for-service” model rewards caregivers for how much they do rather than how well they do it.

Health economists say it does too little to ensure that the people treating a patient know what’s been done by other caregivers. Too often, the result is duplication, waste and mistakes that are both expensive and dangerous to a patient’s health.

But what sounds like a commonsense approach is full of complications. Accountable care relies on a single, bundled payment that’s spread across all caregivers dealing with a patient. In its model, Baylor, with a powerful hold on much of the North Texas hospital industry, will decide how patients should be treated and how the payment pie is sliced. Doctors, hospitals and insurers in North Texas have a hard time trusting each other. And medical professionals don’t like being told how to do their jobs.

Patients may not like it either. The last overhaul of patient care and payments on this scale took place in the 1990s, when HMOs, or health maintenance organizations, were introduced on a wide scale. Patients rebelled against insurers getting between them and their doctors on decisions about care, and they may not see much difference if it’s a hospital rather than an insurance company making the calls under accountable-care.

In 2000, 3 million Texans were enrolled in HMOs. Last year, it was 852,000.

In that decade, however, Dallas changed from an average spender for health care to one of the biggest spenders in America on a per-patient basis.

Congressional Democrats have struggled for months to write legislation that will extend coverage to more Americans, including many in Dallas who lack health insurance. Insurance might persuade some of those people to seek preventive treatments they now skip because of cost. The legislation also encourages communities to try models such as accountable-care organizations, under the theory that doing so will lead to better care at lower cost.

“I don’t think we can really afford to wait for what might happen with national health care legislation,” said health economist Mark McClellan, keynote speaker for Monday’s summit.

“It’s very clear we need to move to more preventive care, and more coordinated care. While legislation can help address that, there are certainly a lot of steps that can be taken in the meanwhile, ahead of health care reform.”

Wooing employers

Roberts said Baylor will not wait for Congress to pass a health care overhaul bill. Instead, he has been going directly to large North Texas employers with a pitch that Baylor can improve quality while lowering costs with an accountable-care model.

“I might go to a Texas Instruments and say, ‘I know you’ve been struggling with your health care costs. Can we help you bend the cost curve?’ ” Roberts said.

Early next year, Baylor will meet with the Texas Employees Retirement System and Blue Cross Blue Shield of Texas to see if it can help slow the growth of the system’s health care costs.

Those costs for the 528,000 participants are projected to be $2.1 billion by year’s end, according to the system’s records.

“We will be looking at a number of innovations in plan design and reimbursement structure, including patient-centered medical homes, clinical integration and an accountable-care organization structure,” Roberts said.

In Baylor’s accountable-care plan, Baylor would be held responsible for organizing its hospitals and physicians to lower costs. In a contract, the employer would have to agree to a number of terms, possibly changing health insurance plans, which could set up fights between Baylor and health insurers. The contract might also require the employer to hire an outside wellness program developer to get workers in shape, Roberts said.

What’s less clear, and more controversial, is whether employers would instruct workers to visit only Baylor doctors and hospitals.

Roberts said he’s unsure what employers will do. If employees are given the freedom to choose their doctors and decide not to participate in Baylor’s accountable-care system, then Baylor has limited power in controlling costs.

If workers are limited to Baylor services, the hospital system secures a steady revenue stream and leverage over regional hospital competitors.

One difficulty facing health providers that are considering accountable-care models is how to sell the idea to patients without their feeling it’s just another cost-control measure.

“The challenge with evidence-based treatment is that sometimes we don’t like what the evidence shows,” said Eduardo Sanchez, chief medical officer of Blue Cross Blue Shield of Texas. Sanchez pointed to the uproar over a federal advisory panel’s recommendations that women younger than 50 don’t need routine annual mammograms screening for breast cancer. The panel warned that early testing causes many more false diagnoses and needless procedures than life-saving cancer detections.

“Does preventive medicine have to save money to be worthwhile?” Sanchez asked. “The response has been that, clearly, it shouldn’t be driven by the idea of saving money.”

how important is Dell’s EHR/EMR project?

I just read that Dell is offering something called the Affiliated Physicians EMR Solution

Possibly reflecting my background as much more of a software than a hardware person, I am not at all sure how much of a game changer this is. Dell is a mighty force in the IT world, no doubt about that. I think there is a pretty obvious logic that medical offices could benefit from a standardized, modularized, low-cost integrated server solution with (say) Linux as the OS and MySQL or MS SQLServer handling queries generated by interacting with an EHR/EMR user-end application.

But while Dell has a proven track record in delivering low-cost solutions, I am not sure why they are an obvious fit for an EHR/EMR solution. Is it because they can sell cheap servers? But why have the server farm at the office at all? Why not run it on the “cloud” at a server farm somewhere? Is Dell wanting more of the hosted applications market? If that is the game, then the medical offices are not necessarily interacting with the hardware provider in any meaningful way, so much as outsourcing their EHR/EMR needs to a hosting company or Software as a Service company.

Of course ensuring HIPAA compliance is no trivial matter, but still…can Dell offer an on-site solution that is better than off-site hosted ones? Physicians typically have more money than time. Maybe the economies of scale involved here with Dell’s plan make it ultimately cheaper to host these mission-critical, data intensive applications yourself?

Maybe Dell is morphing from a hardware company to more of a services company? IBM has made a bundle dropping (relatively) low-margin hardware sales for higher-margin services and support. Nice work if you can get it. I suppose this is part of the strategy for righting the company after going through some difficult quarters even before the recession hit.

According to dell.com

“Together, Dell and participating hospitals are eliminating long-standing barriers to EMR adoption for small and medium medical practices: cost, complexity and interoperability. Dell’s Affiliated Physician EMR Solution lets hospitals sponsor their affiliated physicians with an EMR solution that is interoperable with the hospital’s own health information systems. The solution includes industry-leading EMR and practice management software, hardware systems, and a complete service and support portfolio. Financing options minimize physician up-front and out-of-pocket expenses until ARRA reimbursement starts.

Healthcare providers who adopt EMR and achieve “meaningful use” by 2011 are eligible to receive the maximum reimbursements of up to $44,000 in Medicare or $66,000 in Medicaid from the American Recovery and Reinvestment Act. Reimbursements decline every year thereafter until 2015. Physicians who do not achieve meaningful use by 2015 risk Medicare and Medicaid penalties.

Hospitals:
While many hospitals offer their affiliated physicians “access” to the hospitals’ health information systems, this still doesn’t manage the totality of patient care. In order for true coordinated care to exist, physicians and their patients must be connected with hospitals before admission. By sponsoring this EMR program, your hospital will be building this connection. Together with Dell, your hospital plays a pivotal role in supporting physicians with the ability to accelerate the use of health information technology, improve patient safety, and reduce healthcare costs.

Affiliated Physicians:
The question isn’t if you’re going to transition to electronic medical records (EMR). It’s when. But, faced with all of the decisions and regulations, getting from here to there can seem daunting. That’s where Dell comes in. Dell has created a comprehensive solution that simplifies EMR adoption and management, allowing you to focus on your mission of improving patient care”

The Austin American Statesmen has an article that reads like a press release:

“Health care is a valuable new target sector for Dell. The company has relied increasingly on sales to government in recent quarters to make up for big drops in computer spending by large corporations.

Dell said its early partners in the electronic records program include Tufts Medical Center in Boston and the Memorial Hermann Healthcare System in Houston.

Tufts, along with the New England Quality Care Alliance industry group, worked with Dell to design the program.

Dr. Jamie Coffin, Dell’s vice president for health care and life sciences, said Dell’s program helps attack the digital divide in the medical system where hospitals and affiliated doctors do a poor job of sharing patient records.

“Patient information that is locked away in paper records, electronic medical records solutions that are beyond the reach of most physician practices,” Coffin said. “Hospitals and physicians share patients, but not patient information. With our hospital partners, we are knocking down (electronic medical records) barriers.”

Analyst Judy Hanover with IDC said Dell has introduced one of the first comprehensive solutions for hospitals and affiliated doctors.

Elecronic medical records technology “has existed fore nearly 20 years, but cost, complexity and other barriers have kept it beyond the reach of physician practices and many hospitals, the front line of our health care system,” Hanover said.

Dell spokesman Cathy Hargett said her company believes it is important for hospitals to be the lead partner in such systems so that affiliated doctors can invest in compatible records systems.

The computer maker is plans to work with a variety of software vendors including eClinicalWorks to deliver the applications that hospitals and doctors want to use. Dell will provide a variety of services to help hospitals and doctors practices to set up such systems – including financing, needs assessment, work flow consulting, system configuration, software installation, training and support’

the place in America where healthcare costs are highest: McAllen TX

from the June 1, 2009 New Yorker:

“Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.

The explosive trend in American medical costs seems to have occurred here in an especially intense form. Our country’s health care is by far the most expensive in the world. In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control. Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government. “The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”

The question we’re now frantically grappling with is how this came to be, and what can be done about it. McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers.

From the moment I arrived, I asked almost everyone I encountered about McAllen’s health costs—a businessman I met at the five-gate McAllen-Miller International Airport, the desk clerks at the Embassy Suites Hotel, a police-academy cadet at McDonald’s. Most weren’t surprised to hear that McAllen was an outlier. “Just look around,” the cadet said. “People are not healthy here.” McAllen, with its high poverty rate, has an incidence of heavy drinking sixty per cent higher than the national average. And the Tex-Mex diet has contributed to a thirty-eight-per-cent obesity rate.

One day, I went on rounds with Lester Dyke, a weather-beaten, ranch-owning fifty-three-year-old cardiac surgeon who grew up in Austin, did his surgical training with the Army all over the country, and settled into practice in Hidalgo County. He has not lacked for business: in the past twenty years, he has done some eight thousand heart operations, which exhausts me just thinking about it. I walked around with him as he checked in on ten or so of his patients who were recuperating at the three hospitals where he operates. It was easy to see what had landed them under his knife. They were nearly all obese or diabetic or both. Many had a family history of heart disease. Few were taking preventive measures, such as cholesterol-lowering drugs, which, studies indicate, would have obviated surgery for up to half of them.

<snip>

Some were dubious when I told them that McAllen was the country’s most expensive place for health care. I gave them the spending data from Medicare. In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average. But since then, year after year, McAllen’s health costs have grown faster than any other market in the country, ultimately soaring by more than ten thousand dollars per person.

“Maybe the service is better here,” the cardiologist suggested. People can be seen faster and get their tests more readily, he said.

Others were skeptical. “I don’t think that explains the costs he’s talking about,” the general surgeon said.

“It’s malpractice,” a family physician who had practiced here for thirty-three years said.

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

“Practically to zero,” the cardiologist admitted.

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ”

Everyone agreed that something fundamental had changed since the days when health-care costs in McAllen were the same as those in El Paso and elsewhere. Yes, they had more technology. “But young doctors don’t think anymore,” the family physician said.

The surgeon gave me an example. General surgeons are often asked to see patients with pain from gallstones. If there aren’t any complications—and there usually aren’t—the pain goes away on its own or with pain medication. With instruction on eating a lower-fat diet, most patients experience no further difficulties. But some have recurrent episodes, and need surgery to remove their gallbladder.

Seeing a patient who has had uncomplicated, first-time gallstone pain requires some judgment. A surgeon has to provide reassurance (people are often scared and want to go straight to surgery), some education about gallstone disease and diet, perhaps a prescription for pain; in a few weeks, the surgeon might follow up. But increasingly, I was told, McAllen surgeons simply operate. The patient wasn’t going to moderate her diet, they tell themselves. The pain was just going to come back. And by operating they happen to make an extra seven hundred dollars.”

Uwe E. Reinhardt: healthcare comparative effectiveness analysis and cost-effectiveness analysis

from http://economix.blogs.nytimes.com/2009/03/13/cost-effectiveness-analysis-and-us-health-care/

With so much brouhaha over what should be thought of as basic operations research for health care, it may be well to explore what “comparative effectiveness analysis” is, and how it is related to what is known as “cost-effectiveness analysis.”

The sketch below describes the basic structure of “comparative effectiveness analysis.”

It is assumed that researchers compare two therapies aimed at the same medical condition. The researchers try to determine which of these therapies can be judged “better” in terms of the positive and negative consequences associated with them. In principle, the clinical practice guidelines promulgated by medical specialty societies to help physicians with their daily treatment decisions should be based on this type of carefully structured comparative effectiveness research.

Source: Uwe Reinhardt A diagram of comparative effectiveness analysis.

Alas, in practice most of the currently promulgated guidelines lack that kind of rigorous scientific foundation. For example, as the science reporter Ronald Winslow recently reported in The Wall Street Journal “just 11 percent of more than 2,700 recommendations approved by cardiologists for treating heart patients are supported by high-quality scientific testing, according to new research.”

That circumstance alone justifies spending billions more than we traditionally have on operations research for an industry that now absorbs $2.5 trillion or close to 17 percent of our gross domestic product. Why anyone would oppose that kind of research challenges one’s imagination.

Early drafts of the economic stimulus bill, however, referred not only to “comparative effectiveness research,” which keeps the analysis strictly in the clinical realm, but also to “comparative cost-effectiveness analysis,” which brings economics into the inquiry. That analysis seeks to establish which of several alternative therapeutic strategies capable of achieving a given therapeutic goal is the least-cost strategy. It seems a sensible form of inquiry in a nation that is dismayed over the rising cost of its health care.

Indeed, in recent years most industrialized nations have begun to subject clinical practices in their health systems to this type of analysis, as have private insurers in the United States (see, for example, the American Journal of Managed Care).

In Congress, however, the word “cost” in this connection remains anathema. This is despite the fact that that same Congress rings its hands in despair over the millions of American families priced out by the ever-rising cost of health care, and over the bigger chunk of the federal budget taken up by Medicare and Medicare.

So, in the end, the offensive term “cost-effectiveness analysis” was stricken from the bill.

The opposition to cost-effectiveness analysis in health care comes from two distinct groups that work closely together and reinforce one another.

The first group includes individuals or enterprises that book other people’s health-care spending as their own health-care income.

The manufacturers of pharmaceutical and biotechnology products or of medical devices are often found in that group, even though in some instances the greater economic transparency provided by cost-effectiveness analysis might help them market their health products or health services. Also in this group are physicians who thrive economically from highly resource-intensive medical treatments, even if some of its components are of only marginal clinical benefit.

The second group among the opponents of cost-effectiveness analysis includes individuals who sincerely believe that health and life are “priceless” — for them, cost should never be allowed to enter clinical decisions. It is an utterly romantic notion and, if I may say so, also an utterly a silly one. No society could ever act consistently on such a credo.

Ephraim Schwartz: Financial and technology issues make Obama’s EHR push not so easy to execute

from www.infoworld.com/article/09/03/11/10FE-electronic-medical-records_1.html

Up until now, the benefits of electronic medical records that have occurred accrue to just about everybody — patients, employers, state and federal governments, and medical insurers — but the actual health care providers. Doctors get the least benefits, especially in small practice groups (those with fewer than five physicians) that make up most medical practices.

But even those who might benefit from electronic health records don’t, says Homer Chin, associate medical director for clinical information systems at Kaiser Permanente Northwest. Why? Because there is little incentive to share information, the core of an electronic health record (EHR; also called an EMR for “electronic medical record”). For example, hospitals make money by doing tests. But once EHRs are up and running, a doctor ordering a test electronically might immediately receive an alert saying the test was unnecessary because the patient had the same test or procedure at another location. “There is not much revenue and profitability in putting in an EHR. There is little financial incentive,” Chin says.

An ironic consequence of EHRs is that, by helping raise the quality of health care, they penalize doctors and other medical providers for success, says Wes Rischel, a vice president at Gartner. The bottom line: Doctors will see fewer patients.

Beyond the income factor, the high cost of EHR systems today — not only the systems, but the setup and training — also dissuades adoption by doctors, especially those in small groups. Physicians have been unwilling to invest anywhere from $20,000 to $50,000 in an EHR system where the economic benefits tend to go to someone else. Today’s EHR systems are not as easy to use as they could be, so there is a large learning curve required, Chin says: “There is something intuitive about paper chart and prescription pad.”

Recognizing these factors, the stimulus package tackles these financial challenges head on by offering money to health care providers. Hospitals submitting via EHR systems to Medicare and Medicaid will receive up to $6 million a year in additional payments for sending data electronically. This incentive will remove much of the adoption inertia seen so far, says Richard Archer, a principal in the health care IT advisory practice a KPMG.

<snip>

But now Microsoft, Google, and AOL founder Steve Case’s Revolution Health are looking at entering the health care information exchange market. All three offer individuals a personal health record, which puts the patient in control of his medical information. But the business aspect is in giving health care providers access to a person’s complete health record from a single site.

There are two major questions around the reliance on health records from these providers, say industry analysts. One is whether users will trust a for-profit organization to care for the most personal kind of information. The second is whether each of us can be trusted to manage and keep such a life-and-death record up to date or if it’s safer to leave that responsibility to organizations whose only job it is to keep the health data updated.

The prognosis for EHRs
EHR providers are, not surprisingly, bullish on the future of EHR efforts. Greg Mancusi-Ungaro, a senior director at Exigen Systems, says deploying an EHR system is just like implementing any big enterprise application, only the enterprise in this case is bigger and the stakes are higher. “The technology exists today and despite the fact that we lack some core standards, we are enabling the development of a flexible infrastructure to stay in tune with requirements. I can visualize a successful national system,” he says.

As Kaiser’s Chin points out, there is a convergence occurring around health care technology regarding how to share it and use it to assist delivery of services and treatment. But the challenge of orchestrating and satisfying so many stakeholders remains. Plus, even if the solutions are mandated rather than eventually negotiated, the task of gathering the many pieces that are still in flux, then integrating them remains a complex technical and process task.

Over time, both industry representatives and analysts expect that every U.S. citizen will have an EHR available nationwide. But to make it happen will require a great deal of cooperation, innovation, and an investment in health-oriented IT. This shift will likely start at a less ambitious level than the political rhetoric suggests, with local practitioners sharing patient information in a local health care ecosystem.

5 guiding principles for spending EHR stimulus funds wisely

John Halamka, MD,  on Making Smart Investments In Health Information Technology: Core Principles

http://content.healthaffairs.org/cgi/reprint/28/2/w385.pdf

Over the past five years, thousands of public- and private-sector employees, many volunteering their time, have worked to advance the cause of interoperable, certified, secure electronic health records. As new federal funds become available, should we invest right away or wait for technology and policy perfection? Do we leverage the accomplishments of existing national organizations, or do we start from scratch? The time to invest is now, building on the organizations we already have. To ensure wise investment, I suggest guiding principles assembled from the input of hundreds of providers, patients, payers, vendors, government employees, and standards-development organizations.

No other industry has had such a mismatch between the sophistication of the technology being introduced and the lack of technological sophistication on the part of those who are supposed to manage it. Placing servers in clinicians’ offices and expecting office staff to back up, secure, and maintain technology is likely to be expensive, frustrating, and highly risky. Investments in EHRs should focus on achieving economies of scale through the funding of regional, hospital based, or vendor-hosted “software as a service” providers that provide Web-based/remotely accessible solutions that require very minimal new technology in clinicians’ offices.

NYTimes: Bad medical imaging is a growing problem

www.nytimes.com/2009/03/02/health/02scans.html?ref=health

Many factors contribute. Insurers pay the same for a scan done on a 10-year-old machine as one on the latest model, though the differences in the images can be significant.

Insurers do not distinguish between scans that are done poorly or done well or read by less- or more-qualified doctors. Aside from mammography, whose standards were established by a law that went into effect more than a decade ago, the field is largely unregulated. And increasingly, doctors refer patients to scanning centers they own and profit from.

Ten years ago, the age of a scanner might not have mattered so much. Now, said Dr. Gary Glazer, the chairman of radiology at Stanford, technology has advanced so much that the older scanner “is not the same machine.”

“I can tell you from my experience that between those extremes the gap is huge,” Dr. Glazer said.

Yet, he added, many scanning machines used today are a decade old.

Imaging centers can, if they choose, become accredited by the American College of Radiology. That requires, among other things, scanning a phantom, a device that simulates a body part. Technologists must also be certified, and there are standards for supervising physicians. And the scanners must be regularly assessed to ensure they are properly functioning.

But many centers are not accredited, although the percentage is not known because there is no national registry of imaging centers.

Accrediting will be partly addressed by a little noticed aspect of a wide-ranging Medicare law passed last year. After it goes into effect in 2012, Medicare will pay only for scans done at accredited centers. But imaging experts say the law fixes only part of the problem. High-tech scanning is complicated, and there is no consensus on objective measures to ensure quality. Even with the new law, there is still little assurance that scans will be appropriately ordered and interpreted or that a scanner will be up to date.

Radiologists are struck by the wide variation in the quality of scans, and they say there is little patients can do other than to ask why the scan is necessary and, if it is, to ask about accreditation, the credentials of the person reading the scan and the age of the scanner.

“The studies I see coming from the outside vary from marginal quality to very good quality,” said Dr. Chris Beaulieu, a Stanford radiology professor. “Some of it is related to equipment, and some is related to people with very good equipment who don’t know how to use it right. And on the interpretation side, there is also a very wide range of quality or accuracy, in my opinion.”

Interpretation can be crucial, Dr. Beaulieu added. “A good radiologist can sometimes accurately read scans off of a lower-quality scanner,” he said. “I see that all the time. A good radiologist and a lower-quality scan could be better than a bad radiologist and a good scan.”

But logical as it might seem to pay more for a better scan, there are problems. Health insurers have no way of knowing whether scans are good, said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group. Doctors, not insurers, receive the images and reports, and all insurers can do is notice if there are frequent requests to redo scans from a particular center.

Physicians to receive incentives for EHR, penalties

from www.healthcarefinancenews.com/news/physicians-receive-incentives-ehr-use

The American Recovery and Reinvestment Act of 2009 provides financial incentives to physicians who adopt and use Electronic Health Record (EHR) technology. However, physicians who haven’t adopted certified EHR systems by 2014 will have their Medicare reimbursements reduced by up to 3 percent beginning in 2015.

The act provides $20 billion in health information technology funding, divided between $2 billion in discretionary funds and $18 billion in investments and incentives through Medicare and Medicaid, to ensure widespread adoption and use of interoperable healthcare IT systems.

“In one stroke, Congress has all but removed the biggest stumbling block to EHR adoption – cost,” said James R. Morrow, MD, a physician at North Fulton Family Medicine in Alpharetta, Ga., who was named “Physician IT Leader of the Year” by the Health Information and Management Systems Society (HIMSS). “It’s time for doctors to stop complaining about the cost of an EHR and take the ball and run with it toward the goal of better medicine with better records and information sharing across the healthcare team.”

With the stimulus, the Centers for Medicare and Medicaid Services will pay physicians $44,000 to $64,000 over five years, beginning in 2011, for deploying and using a certified EHR. The stimulus package is expected to ignite significant job growth in the information technology sector and, according to a Congressional Budget Office review, drive up to 90 percent of U.S. physicians to EHRs in the next decade.

A recent Allscripts survey of 1,888 healthcare professionals revealed that 98 percent of physician practices would take advantage of the incentives or would be closely evaluating the opportunity.

hat-tip-www.fiercehealthcare.com

CEO of athena Health: a Federal “Marshall Plan” for Electronic Medical Records will fail

http://histalk2.com/2008/12/22/histalk-interviews-jonathan-bush-ceo-president-and-chair-of-athenahealth/

Money quotes from Athena Health CEO:

“In life and society, the goal of government is to set the rules of the road for companies. If the government intervenes and actually becomes a participant, there’s all kinds of adverse skewing that’s going to go on.

Certainly this is a world class case in point. If we end up with a Marshall Plan for EMRs, we will subsidize the approach to this that has not worked, that is certainly, among the readers of your site, clearly known to be a failed approach. We’ll keep those established players, those dominant buffoon gigundo companies, alive a little bit longer. It really feels like subsidizing General Motors. Who else would help save America from having access to cars that nobody wants?

I really feel that way about these big EMR, clinical, software-only business model companies. Nobody wants them. They’re being told that they should have them, but in their hearts, if you look at their Id, they don’t want them.”

I don’t want the Obama investment in healthcare to end up looking like the Congressional investment in General Motors, which is to say I don’t want really, really bad, dead things that ought to die sooner to be kept alive longer by a well-meaning federal government. I want software companies to die as quickly as is humane.

If the federal government gets in there and starts handing out free subsidies, then the providers of the world have to say, “Well, gee, I know it sucks, but if it’s free, does it suck that much, or maybe I should give it one more swing?” That’s what scares me to death. That’s why the interview with Wall Street Journal and with Fox and anybody else who will talk to me, including you. To make sure the Obama folks hear us saying, “Please don’t kill the emerging technologies by subsidizing the established and dying technologies in order to have something to do.”

Q-Is the track record of doctors and hospitals who have already implemented the available technology good enough that we should be subsidizing more of the same?

The hyperbole is almost ringing as you ask. You’re the ultimate insider and I know that you know that the answer is no.

The folks who have installed this stuff are experiencing negative ROI. That’s why the RAND Institute came out with the study that showed that it’s 19% slower to have an EMR. There’s no pay-for-performance revenue to cover that 19% slowness. None of the supply chain is connected to EMRs, so all the laboratories and specialists and X-ray machines and PET scanners and mammogram machines aren’t connected to EMRs. There’s an incremental administrative cost in keeping the EMR current by typing results into the chart from these other sources of medical information.

Everybody knows in their heart of hearts that without a massive increase in pay-for-performance … it’s not really even performance at this point, it’s really pay-for-data … without a massive increase in pay-for-data in hopes that will prime the pump and we’ll figure out how the data maps to performance later. I’m sitting here looking at a row of plastic white yachts in Boca Raton and I’m thinking, “What is the definition of a yacht? A hole in the water into which one pours money.” I think of EMRs a lot like that … data yachts.