Legislation that took weeks to write will wreak havoc for years.
Though some Cliniticos (clinicians turned politicos) increasingly refer to HITECH as a “brilliant” piece of legislation, it’s clear the impending market damage is only now coming into focus.
My unpalatable HITECH morsel of the moment centers, generally, around the lack of healthcare IT workforce necessary to make the legislation’s goals a reality and, more specifically, the bizarre market dynamics that will be precipitated by the half-baked Regional Extension Center (REC) farce.
Let’s do what Congress and the lobbyists didn’t — think this through logically. HITECH calls for the industry to work towards a goal at the same time it is defining that goal (meaningful use). I have been told, “That’s the way life works,” by some, but I just can’t figure out what that means. Any project manager worth his salt will tell you it’s critical to have a vision of the end point when designing a strategy. I’ve spoken to a number of people who say that, rather than spurring the market, HITECH has put much activity on hold. People, it seems, do want the clarity some say they shouldn’t require.
At least HITECH took care of the financing issue around EMRs, though it offered no money upfront to support purchases. Many say this is the most “brilliant” part of the legislation, not merely paying for a system, but rather its meaningful use. OK, maybe brilliant is a bridge too far (we didn’t split the atom here), but that’s a sensible plan to make sure tax monies are well spent.
But maybe it didn’t solve the funding issue after all, as cash-strapped providers that scrape together the purchase price often have nothing left for critical consulting help needed to select the right system, negotiate a contract and redesign workflow.
While the government could have solved that by providing some upfront funding for providers to hire existing consultancies, it chose instead to mandate the creation of 70 RECs. These organizations will receive taxpayer funding, averaging $8.5 million, but can charge providers whatever they want. Thus, there’s no guarantee they’ll be a more cost-effective solution to what’s currently offered on the market. These organizations only have to come up with a 10 percent match on operating costs and can pump whatever “profits” they make back into the organization (see salaries, T&Es, etc.).
As if the proposal wasn’t bad enough, the mandate for these organizations borders on the ridiculous. RECs are supposed to help approximately 1,000 primary care providers become meaningful users of certified EHR technology within 24 months of receiving their first financial infusion. Running the numbers shows that each center would have to make a meaningful user out of more than 40 practices per month, many of which are not even on an EHR today. With the scope of their mandate including system evaluation, selection and on-the ground technical assistance, it’s unclear how success is possible.
Also On Healthcare-Informatics...