As soon as President Obama signed the Patient Protection and Affordable Care Act into law in late March, CIOs, policy leaders and industry observers began trying to gauge its potential impact, as well as how it might relate to the HITECH Act's meaningful use requirements.
“I have read the bill and it is complex to understand,” says David Muntz, senior vice president and CIO of the Baylor Health Care System in Dallas. “It's kind of mind-boggling, but everyone is going to be impacted.”
Muntz, who chairs the CHIME Advocacy Leadership Team for the Ann Arbor, Mich.-based Center for Healthcare Information Management Executives (CHIME), says many of the reforms are valuable, but he adds that CIOs might initially have trouble translating the goals of the huge macro-economic proposals down to the environment of their individual facilities. “The challenge for me is making an accounting of the costs and benefits of reforms that are inter-enterprise.”
The day after the bill was signed, David Blumenthal, M.D., National Director for Health IT, told the Health IT Standards Committee of the federal Office of the National coordinator for Health IT (ONC) that he was moved by watching the signing ceremony, and hoped standards committee members felt invigorated by the reminder that their work is “front and center in terms of what the healthcare system needs to accomplish in the next five to 10 years.”
Although noting that some of the new law's impact on health IT development may be indirect, Blumenthal said that its cost-saving assumptions include “that the work we are doing will enormously empower many aspects of the health system - administrative simplification, accountable care, quality measurement, the ability to coordinate care through medical homes, and the ability to create a primary care work force that is enabled to provide high-quality primary care.”
One key element of the healthcare reform bill is on quality reporting, and that really does build on the HITECH Act, says David Roberts, HIMSS' vice president of government relations at the Chicago-based Healthcare Information and Management Systems Society (HIMSS). The secretary of Health & Human Services is required to develop reporting requirements to improve health outcomes, he says, and HHS will have to determine where there are gaps in quality measures and focus on developing new measures to fill those gaps.
“CIOs will have to be aware that as they focus on the meaningful use stages, new quality reporting metrics will be coming down the pike,” says Roberts, who adds that the hiring of Donald Berwick, M.D., president and CEO of the Cambridge, Mass.-based Institute for Healthcare Improvement, to lead the Centers for Medicare and Medicaid Services (CMS) sends a great signal that the focus will be on paying for quality rather than on paying for episodes of care.
Quality measures clearly play a central role in both the HITECH and health reform pieces of legislation, and many of the IT tools expected to meet reform goals are already being developed to meet meaningful use requirements. “CIOs will have to continue to develop the business analytics capabilities to produce these types of reports,” says Lynn Dunbrack, program director for provider/health payer research at Framingham, Mass.-based IDC Health Insights. Also, technology tools that help with the dissemination of best practices and evidence-based medicine will go a long way toward meeting some of the reform measure's goals. As she wrote in a recent report, there is a natural progression from collecting and sharing data to creating guidelines, protocols and actionable advice to enable cost reductions and better outcomes.
Pressure for greater efficiency. The expected increase in the number of patients with insurance coverage will put pressure on providers to see more patients, Dunbrack adds. IT leaders will be tasked with finding innovations that give providers efficient ways to see more patients in the same amount of time.
Efforts to develop bundled payment pilot projects and medical home demonstrations will require new IT tools to help understand the total cost picture and allow providers to collaborate with others in the community, Dunbrack says. That might involve both physician and patient portals focused on preventive care and patient self-care for chronic conditions. Meanwhile, Rich Umbdenstock, president and CEO of the Washington, D.C.-based American Hospital Association, noted recently that AHA member hospitals would welcome a leadership role in pilot programs that bundle and coordinate provider payments.
The new law may require both the development of new systems and new roles for the CIO, noted L. Michelle Issel, Ph.D., R.N., editor-in-chief of the Health Care Management Review. In the April/June 2010 issue, Issel, a clinical associate professor in the School of Public Health at the University of Illinois at Chicago, wrote that one provision is to reduce Medicare payments for preventable re-hospitalizations. To prevent re-hospitalizations, hospitals will need to develop more adept systems to monitor and prevent post-hospitalization complications.
While addressing many large issues around payment reform, the act also contains detailed health IT provisions on issues that many CIOs are likely already dealing with. For instance, it requires HHS to receive input on whether revisions should be made to the crosswalk between ICD-9 and ICD-10 that is on CMS's website. Likewise, calls for financial and administrative simplification build on efforts already under way.
Baylor's Muntz says one major concern is the provision in the reform legislation that mandates an excise tax on biomedical equipment. Set to begin in 2013, the 2.3 percent tax is expected to raise $20 billion over the next 10 years. “That 2.3 percent could have a huge impact on organizations already spending tens of millions on such equipment,” he says.
HIMSS' Roberts says that many people have been overwhelmed trying to digest all the information in the bill, and many are not clear what is hype and reality about the legislation, but he believes it is going to have a “major positive impact.”
But even if it hadn't passed, Roberts says, the momentum for health IT developments wouldn't have abated.
“President Obama has made clear that in the movement toward universal coverage, they first had to lay the groundwork, which included interoperable health records,” he explains. “This is a building block process, so even if this bill hadn't passed, the incentives in HITECH still would have laid the foundation and still would have been the priority for providers.”
Healthcare Informatics 2010 May;27(5):36-37