How did we get into this economic mess? The partial answer is people borrowed money on terms they did not comprehend, or terms that were not fully disclosed. Then a couple of years later one fundamental rule changed — housing values, it appears, can go up and down, and yes Virginia, you can lose big money in real estate.
So now hospitals under the new American Recovery and Reinvestment Act (ARRA) are being given the same wonderful opportunity. Borrow money from your rich (but debt ridden) Uncle to buy a shinny new EMR and agree that he can define the interest and repayment terms when he gets around to it. The recent HIMSS conference was replete with sessions telling you; Get the money now, buy a system soon, you don’t want to get hit with a penalty in 2015, and make sure you get your piece of the pie.
So like lemmings to the ledge we run.
When the rest of the world is yelling at you to jump with the lemmings, why wait?
There are at least three big reasons.
1) When was the last time you saw ‘on time’ regulation?
I have worked the healthcare industry for 35 years and cannot remember one major piece of legislation that met its original target dates. I lived through TEFRA, DRGs, HIPPA, UB-82, ICD10 and dozens of others. Not one made the original and, in many cases, second target dates. Amtrak has a better on-time schedule. What makes us think ARRA will be any different? I’ll bet my reputation that all the dates get pushed out, probably by years.
2) Meaningful what?
Nobody knows and the committee will decide. So what happens after you sign on the dotted line and two years later you learn the system cannot support all the meaningful use measures the committee came up with? I know what you’re thinking. Sue the ### vendor!
But that assumes the vendor allowed a clause in the contract warranting performance for all ‘meaningful use criteria.’ And that clause will no doubt go on for pages, since there could be cases where the system has the tools to support meaningful use, but it doesn’t fit with your workflow, and staff is not willing to deploy it.
Under Sarbanes Oxley, vendors that are public companies cannot book any revenues on contracts with open-ended contingencies. Getting a vendor to sign on that dotted line will be a super major task. Private companies like Epic and Meditech don’t have to worry about quarterly revenue pressure so they may be more willing. But still they could be taking on significant product liabilities. This one will be a big revenue generator for the lawyers.
3) The feds giveth, and the feds taketh away, or there is no such thing as a free lunch.