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"Plus ça change, plus c’est la même chose"… Or Perhaps Not?

March 3, 2012
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Will we look back on HIMSS12 as a key inflection point for our industry?


Amid the swirl of the HIMSS12 conference held Feb. 21-24 at the Venetian Sands Expo Center in Las Vegas, it was impossible not to get caught up in the frenetic whirlwind of energy that is the HIMSS Conference every year. All of us—whether healthcare and healthcare IT leaders, vendors, consultants, industry analysts and observers of various types, journalists, or of any other possible category of attendee or participant—find ourselves pulled into the unique HIMSS Conference vortex each time it comes around; and on a human level, that’s absolutely understandable (if not unavoidable).

Still, amid all the activity and buzz, the French phrase, “Plus ça change, plus c’est la même chose”—the more things change, the more they stay the same—came to my mind more than once, and made me wonder whether in fact, with HIMSS12, and particularly with the release of the meaningful use Stage 2 proposed rule, our industry might have reached a very key inflection point.

Here’s the thing: for years—decades, really—we’ve had a rather curious situation, in which a small number of pioneering patient care organizations have been speeding ahead of everyone else, and making progress in every crucial area demanding change in healthcare—improving patient safety and care quality, enhancing clinician effectiveness, controlling costs, creating far greater accountability and transparency, and leveraging information technology to facilitate all those goals; while the broad majority of patient care organizations have until now for the most part lagged behind, for whatever reason or reasons.

And even as the pioneers and their cousins, the early adopters, have been engaging very aggressively in clinical transformation and in the transformation of all of their key care delivery and operational processes, a significant proportion of their fellow hospitals, medical groups, and integrated health systems, have hung back, remaining stuck in their operational stasis, and unable (and perhaps, in some cases, also more than a little bit unwilling) to begin moving down the path to transformation.

Now, however, those patient care organizations that have not yet made significant progress are faced with a range of federal mandates, certain to be backed up by copycat mandates from private payers—that will simply no longer allow hospitals and physicians to maintain the status quo.

Think about it: there are three very important mandatory programs that the Affordable Care Act has mandated via the Medicare program, and which are set to cut provider reimbursement for substandard performance, in the next few years—the avoidable readmissions reduction program, the healthcare-acquired conditions reduction program, and the value-based purchasing program—with only that third program offering the potential for payment increases as well (for high-performing organizations). Then there are the two big voluntary programs under healthcare reform: the accountable care organizations shared savings program, and the bundled payments shared savings program, both also under Medicare.

And, for our core healthcare IT leadership audience, there remains, looming above everything else, the meaningful use process under the HITECH Act, which, like the first three healthcare reform-driven programs mentioned in the paragraph above, is mandatory, and involves reimbursement cuts down the road for some provider organizations. Plus, of course, there is the required transition to the ICD-10 coding system, which, even with its announced temporary delay, will be compelling all providers forward in the near future along that dimension.

So those organizations not at the front of the pack, or even closely behind the front of the pack, are faced with a veritable tsunami of challenges; and unfortunately for them, it’s a tsunami that could literally prove fatal to their organizations over time, if they don’t begin to move forward on all of these fronts, at least the mandatory ones. As Jane Metzger and Erica Drazen of CSC have articulated to me through their articulation of their team’s studies and white papers over the past year, over the next several years, the reimbursement cuts coming out of the readmissions reduction, healthcare-acquired conditions, and value-based purchasing programs under Medicare could eventually total as much as 9 percent of Medicare annual payment, for hospital organizations in the lowest quartile in all three areas. And as we all know, for most hospitals, a 9-percent overall Medicare pay cut could be terminally devastating. And that doesn’t even count the anticipated reimbursement cuts for hospitals that fail to meet meaningful use by 2015.

Now where the proverbial rubber really meets the proverbial road, I’ve found over and over in my reporting over the years, is along the critical dimension of culture. In all the interviewing I’ve done of healthcare leaders over the past 22-plus years in healthcare, it’s become crystal-clear to me that patient care organizations with the right types of leadership and culture have consistently been those that not only survive change, and more specifically, payer and purchaser demands, but also thrive, in change-driven environments.

So what does this mean for the organizations currently behind the curve in terms of the care delivery transformation now being demanded of providers on a nationwide basis? If anything was clear at HIMSS12, it was that our industry is hurtling forward at an unprecedented rate of change. And, I would add, that operational stasis is no longer tenable.




Another great post. You captured the present moment and the context of what has come before brilliantly.

Shortly after returning from HIMSS, on a Sunday afternoon, we received a voice mail. Although my son's quick strep throat test had been negative on Friday, the culture grew out strep on Sunday and it was time to go to the Walgreens and get an antibiotic. Through prior experience with my son, or Quantum physics, or perhaps simply motherhood, my wife confidently knew the diagnosis before the strep test was even done. You can guess how she felt. I was dispatched to pick up the antibiotic.

"Oh and one more thing dear. Can you pick up a new toothbrush? The old one will, of course, be covered with strep. We'll need to throw that away and switch to a new one."

That toothbrush is the key to the information and communication technologies (ICT) required to address healthcare, health and cost containment. True for accountable care, shared savings of all sorts, affordable care, and safe-quality care. Without that two dollar toothbrush, there would be two more office visits, a change in antibiotic (because the first apparently didn't work), four weeks added to the length of the episode of care, and a chance at further infection and death.

At HIMSS, Farzad said "Let's make meaningful use of meaningful use." In this case, the eRx order sent for strep throat treatment should include a toothbrush. And the kiosk in Walgreens should tell me, within seconds of entering the store, not only my copay, but that my commercial insurance carrier is pleased to pay for the tooth brush, (which will save them $198 and concurrently deliver better, faster, cheaper care.).

Not only was HIMSS a whirlwind. Our lives have become a whirlwind, too. We need the technologies of MU, and, to use them meaningfully. As was evidenced at HIMSS, the pieces are falling into place. Pieces of technology, unfortunately, are just that. Many parents I met at HIMSS have been working in HCIT for two decades or more. No one is getting prescriptions for tooth brushes from their EHRs. We have the technologies; apparently, we don't understand the problems well enough.

How should a provider organization get the electronic prescription bundle for a strep throat implemented correctly? Perhaps I'll learn at HIMSS 2013?

Joe Bormel,

Thank you so much for your exceptionally thoughtful comment!

I think your example of the toothbrush encapsulates perfectly where meaningful use should be headed. What a great example! (And of course, I hope your son is feeling much better already!!) What strikes me in particular about it--and I'm guessing you chose this as an example for how illustrative it was in that regard--is how SIMPLE the toothbrush aspect is in one sense, yet how complex in another. On the one hand, a toothbrush is just a toothbrush, right? There's nothing clinically complex about it. On the other hand, what's complex is the information technology facilitation of key processes that must trigger alerts and actions at just the right moments along the way. That, obviously, is the complex part.

And as I speak with CIOs, CMIOs, and their colleagues in patient care organizations, it strikes me that there are so many levels on which all of this must be made to work, in order for MU to fulfill its promise. I loved what you wrote here: "Our lives have become a whirlwind, too. We need the technologies of MU, and, to use them meaningfully."

The challenges are great, but I also agree with you that "the pieces are falling into place." And I'm passionately dedicated to doing my small part in bringing together the smartest people in the industry in our pages and on our digital platform, to meet, discuss, and help solve the problems along the way and to innovate on behalf of patients and communities.

Thank you for your exceptional comment, Joe!

Thanks Mark. In this season of MU2 (Meaningful Use, Stage 2, responses to the notice of proposed rulemaking), we have to make choice regarding what we will all be compelled to do. Both the incentive side, as well as the "adjustment" side to follow. (For those haven't received their dictionary update yet, 'adjustment' is the new preferred term for 'payment penalty'.)

Do I need more semantic interoperability between disparate systems, or, better communication to patients, if I can only have one or the other?

I'm not confident that I'd get the toothbrush communicated to my pharmacy, anytime soon after Stage 3. That said, I know that Geisinger can do that kind of thing today (called ProvenCare, wrapped in a patient-provider Pact.) I don't think that a Escript for a recommended but optional toothbrush for a strep throat needs to be anything other than SIMPLE.

[By the way, the first four pediatrician's I asked about this comment said that the toothbrush is right thing to do, and there is no evidence-base behind it. Just sayin.]