Louisville, Ky.-based Norton Healthcare is composed of five acute care hospitals: Kosair Children's Hospital (263 licensed beds); Audubon Hospital (480 licensed beds); Norton Hospital & Norton Healthcare Pavilion (719 licensed beds); Norton Suburban Hospital (380 licensed beds); and Norton Brownsboro Hospital (a brand-new 127-bed facility). Additionally, Norton Healthcare provides service through 10 immediate care centers in the Louisville area. Recently HCI Editor-in-Chief Anthony Guerra had a chance to talk with VP and CIO Joseph DeVenuto about how he’s handling HITECH, among other challenges, at his sizeable health system.
GUERRA: Can there ever be an ROI on these technologies, when we see agreements for $50-100 million, while HITECH can only net a hospital a fraction of that?
DEVENUTO: It’s hard to say. There was an organization in the Northeast that was planning to roll out a practice management system to all its doctors, and they were budgeting around $75,000 to $80,000 a doctor. Well, the maximum those practices can receive under ARRA is $44,000. So that’s what they were budgeting and that doesn’t count the reduced productivity a physician has when he comes online initially over what he’s doing on paper right now. Theoretically, the physician is getting better reimbursement because he’s documented more effectively. But at the end of the day, he’s not seeing as many patients, at least for the first month to three months, that he was seeing prior to the system turning on. How do you factor that into the total cost of the system?
GUERRA: Based on your experience, how are physicians, especially the independent, admitting physicians, reacting to CPOE when they come into the hospital?
DEVENUTO: Well, right now we’re going to turn on CPOE in the new hospital that is being built. And we’ve made it a requirement to practice in the hospital. I think one of the things you will see as a byproduct, especially of CPOE in the hospitals, is an increased use of hospitalists. So I think the days of the general practitioner or internist coming into the hospital to follow their patients and then going back to their offices and seeing another 30 patients are going to be a historical note at some point in the future.
GUERRA: That’s very interesting.
DEVENUTO: I think you’ll see an increase in the use of hospitalist. Plus, hospital medicine is becoming more and more complicated because the acuity level of hospital patients is becoming higher and higher.
GUERRA: So do you think this will happen as a result of the community docs not being able to embrace CPOE?
DEVENUTO: It will be interesting to see how it ties into meaningful use, because while we said we wanted CPOE in the new hospital because of the opportunity to have it from the start, I don’t know that we’ll turn around and say that when we start rolling out CPOE to the other hospitals it will be 100 percent mandatory to practice medicine there. Plus, your ability to mandate it depends on your environment. We tend to be in a very competitive environment, so there’s some leeway and latitude that you’ve got to provide physicians just to deal with that.
GUERRA: You mean to keep those physicians practicing at the hospital?
DEVENUTO: Yes, because referring physicians are who bring in revenue to the hospital.
GUERRA: Do you think there will be physicians who choose to practice somewhere more accepting of their paper-based habits?
DEVENUTO: There may be a very, very small minority of doctors that do that. Like I said, it is the future, and unless you’re not reading anything about your industry or what’s going on, you’ve got to know it’s coming, and you’ve got to see it’s coming. So maybe some of them will try and figure out if they can retire before they have to comply.
I think the hardest job right now would be a small rural CIO that’s got to implement all this stuff to be ARRA compliant, and they don’t have the revenue or the operating dollars to actually buy any of the systems.
GUERRA: GE Healthcare IT just came out with a program where they are offering no-interest financing for their EHR. And they are tying the repayment schedule to when the hospital will receive HITECH funds. I thought that was very interesting.
DEVENUTO: Right, but it goes back to the question of whether an organization will receive enough ARRA funds to actually pay for it.
GUERRA: Well, of course they said that whatever shortfall there may be between the cost of the system and the reimbursement is the customer’s responsibility.