Monday, July 16, 2007

The Train Coming Down the Track

Is your information technology structure from the ‘90s? 1890??

In the next five years we will see a catalytic innovation take hold, and I don’t just mean electronic medical records, personal health records, or web 2.0 applications.
In the past several months we have seen several states release morbidity and mortality statistics from hospitals performing certain procedures. Most of these were selected based upon their high per capita cost. The figures are prominently announced and displayed on easily found web sites. This of course is quite controversial and is resulting in angst of both hospital administrators and physicians alike. Payers want the most “bang” for their “bucks”, that is to say the best possible outcomes for beneficiaries. (i.e., they are not going to pay for “bad results”.
Providers and hospitals have seen this coming for quite some time, but the impact of seeing this data displayed publicly is immeasurable. For those providers and hospitals on the top tier, this gives them a significant advantage when contract talks begin.
Internal quality assurance, outcome measurements and daily updates will be necessary to stay even with
Change management is one key for successful transition to healthcare 2.0. The significance of the paradigm shift in the early 1990s is not lost on health care institutions or the establishment of the RVU for determining reimbursements for services by providers. The lag in understanding the “strategic” shifts which occurred then caused thousands of practice business failures and also hospital shut downs. Even the sea-change of practice management firms could not stave off bankruptcy and/or operational demise. The drive toward multiple levels of management, i.e., IPA, MSO, and HMO with all it’s subsets of responsibility between patient, provider and hospital serves as a rationing method. The new system will not allow for this paradigm.

Consumer advocacy groups have arisen, and are and will be playing significant roles in “health change”.

Perhaps California was the “poster child” for bad things, the emigration of thousands of providers to other states, the cacophony of IPA closures, health plan demise, and the changing nameplates of groups, hospitals and others in the health industry.
It is a fairly simple analysis. (The have’s and the have not’s) The have not’s will not be providing health care in five years.

Not only will having EMR be critical but also additional systems that will enable chronic disease management by “remote control’ and telemedicine. Leveraging the capability of the medical staff to care for SNF patients, and at home chronic patients will enable providers. Payers must come to terms with reimbursements for these modalities, since the ultimate outcome will be to reduce hospital in patient and readmissions as well as needless office calls. Remote telemedicine is here with devices that can provide audio visual contact using dial up technology. Remote sensing of BP, Pulse, and Glucometers is already available, and many more are in development. Other peripheral include the Prothrombin time Micro coagulation System, telephonic stethoscope, digital scale, and pulse oximeter.

Payers have been reluctant to share in the development costs of these systems. Change management must analyze the short term ROI, rather than long term ROIs. Most businesses want to see results in three months ( a business quarter).Successful transition therefore will require carefully focused change implementation in limited areas and progress as each gains ROI. (Randy Moore, American Telehealthcare)
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