Caritas Christi Health Care System – the largest community-based hospital network in New England – is in the second phase of its EHR rollout. A few weeks ago, the organization completed an extensive nine-week training regimen with its 1,200-member physician group to lay the groundwork for CPOE adoption and proper use of the EHR. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with Rothenhaus about how the current federal policy initiatives were effecting his plans.
GUERRA: Do you think you’re in good shape to qualify for meaningful use funds?
ROTHENHAUS: I do. I think on the hospital side, we’re covered. I don’t think there’s going to be much that comes up. I am a little bit surprised that everybody is focusing on CPOE because I’ve always felt that, from a risk and a safety standpoint, barcoding medications was probably a stronger intervention than CPOE itself. I would have thought that was actually an easier thing to implement, and it would have been a larger part of the meaningful use discourse, but it tends to be CPOE. We will have both of those things live and in all of our hospitals well before the deadlines.
On the EHR side, in our last two years of rollouts we have essentially 100 percent adoption. Everybody is using electronic prescribing, and they’re doing progress notes properly. So I think we’re probably okay on that.
When I look at meaningful use, there’s a lot of stuff in there which looks like typical pay-for-performance initiatives. We’re ok with it because we’re able get that type of data. I’m not sure what the ultimate attestation is going to look like, it’s confusing to me. I hope it’s confusing to other people as well (laughing). What is a bit of an issue is that you don’t need an EHR to do some of those reporting-type functions; you could just have a hand-written registry.
I’m waiting to learn how all this stuff will work mechanically, because if it’s just as cumbersome as some of the original P4P reporting, that’s a bigger deal than if there’s some attestation required or something bundled to G-codes that says, “I did this with an EHR system.” That’s what I’m really waiting for, because I think as soon as they finally set it, then there’s all the mechanics of how we’ll report it. There’ll be infrastructure and people and personnel that we’ll have to onboard just to get the dollars. It’s going to be interesting to see how it all works.
GUERRA: Do you have any concern for smaller community hospitals that may not be prepared to put in some of these systems? Is there a population of hospitals that will not be able to meet these requirements?
ROTHENHAUS: Well, I think there’s a couple of pieces to that. I am, and I see the stimulus bill as being very destabilizing to the traditional physician-hospital relationship. I think everybody is starting to realize that physicians and hospitals need to work very closely together in order to provide the best care. I think Atul Gawande’s article in the “New Yorker” a couple of months ago really spoke to that. It’s so clear that in places where physicians and hospitals collaborate and there’s communication and transparency, that the care delivered is better. And that’s what’s we’re looking to do here.
But fundamentally I see a couple of things. First of all, hospitals that have already spent the money and done it will benefit the most because there’s almost no work upfront. And the hospitals that haven’t started are going to have to ramp up tremendously in a market where access to capital is almost impossible. So I see all this money filtering down through the states, and there’s no way it can be used directly to support all the hospital system deployments for small- and medium-sized hospitals and small practices.
I think the money should be used to subsidize loans as opposed to a direct payment. It would probably go a lot further and hospitals could at least make a business case to say, “Well, I’m going to borrow money at such a low cost, I’ll be able to implement and recover money on the backside.” I’m not sure it’s enough to defray the cost for the smallest hospitals and the ones that are the most vulnerable, so I think it is destabilizing.
The second thing is that in Massachusetts, we’ve had our EHR program available to physicians in 2007, 2008 and 2009. Since the stimulus bill hit, there have been far more applications than there were in past. So I do suspect that there’s little bit of musical chairs going on with independent or IPA affiliated physicians who are going to look and shop around to get the best deal on an EHR (from a hospital). It’s important to us to have that deal because we want to be an attractive colleague and associate in care delivery.
But I can see that if you’re a hospital that can’t spend anything on EHR adoption for affiliated physicians, you could certainly find that groups are leaving you. These EHR dollars are small compared to the dollars that you’ll see by aligning with different IPAs. I mean the stronger IPAs generate major money, that’s just a fact of life, so this is only a part of the budget for an independent physician practice. But I do think that groups will align with the systems who have more means, just as they have been doing in the past based upon rates they can get from insurance companies.
I think it’s an accelerator to what’s already happening, which is this alignment, almost an exclusive alignment relationship with different health systems as opposed to the freelance doc who admits patients to four or five different hospitals and doesn’t really have a tight alignment with any one of them.