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The Wake-Up Call

February 21, 2011
by David Raths
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Healthcare Reform's Value-Based Purchasing Model HAs as Much Impact as Meaningful Use Requirements on How Hospitals Support Ambulatory Practices

Achieving true IT integration with physician groups may be most successful if it is just one step in a larger overall business alignment strategy, experts say

Pam Arlotto
Pam Arlotto

When it comes to the integration of clinical data between hospitals and physician groups, there are so many moving parts in play that it is difficult to discern which ones are having the biggest impact. Practice consolidation, meaningful use incentives, Stark exception funding, the creation of federal regional extension centers, and private HIEs are all part of the picture.

But in 2011, it is becoming clear that the value-based purchasing movement being driven by the PPACA law, is getting the attention of many physicians who had chosen to ignore the lure of the HITECH Act's incentives for being meaningful users of electronic health records.

Take, for instance, the 650 physician members of St. Francis Healthcare Partners, in Hartford, Conn. Although in 2007 St. Francis Hospital and Medical Center took advantage of the Stark law exception to offer highly subsidized and hosted software from the Chicago-based Allscripts to its physicians, so far only 70 are using the EHR, says Jess Kupec, president and CEO of the physician organization.

Yet in the last six months, Kupec is seeing much greater interest from physicians, and many cite the ACO movement as their motivator. “It took us by surprise. This concept is doing what meaningful use failed to do,” Kupec says. “We have about 90 physicians in the queue right now, and we are hiring eight more people to work on our implementation team.” Physicians are concerned about being left out, he adds, more concerned than about any HITECH Act penalty for not using an EHR.

Health IT consultant Pam Arlotto is hearing much the same thing from her clients. “Reform is scaring them. It is waking them up,” says Arlotto, president and CEO of the Atlanta-based Maestro Strategies. “Value-based purchasing is how they will get paid long-term, so they have to get on board.” She adds that what is needed now is more attention paid to the tools needed for care coordination and the patient-centered medical home.

One industry trend making ambulatory integration a little easier for hospital IT executives is the increasing consolidation taking place among physician groups. In a related development, industry watchers expect the costs associated with joining the patient-centered medical home movement to drive more small practices to merge with larger ones or become hospital employees. Whatever the negative consequences of fewer small practices, consolidation will allow for greater standardization and for larger IT staffs to offer support.

Hospital IT organizations are taking a wide range of approaches to ambulatory integration. Some hospitals are still in wait-and-see mode, while others are working only with employed physicians. Both options may turn out to be short-sighted if hospital CIOs end up trying to support community physicians operating on 10 different EHR platforms. In fact, the degree of clinical integration seems to correlate with the level of business integration. Arlotto suggests that joint ventures set up to provide support should focus on a variety of business services, not just EHR integration.

Jess Kupec
Jess Kupec

Organizations that have been more proactive in reaching out to community physicians are starting to realize the benefits. By using a HIE service from the Warminster, Pa.-based MobileMD, the San Francisco-based Catholic Healthcare West (CHW) has been able to connect 24 hospitals to more than 2,150 of its approximately 10,000 affiliated physicians in just three years. Even if those practices don't have EHRs, they can use MobileMD's portal features, says Scott Whyte, CHW's senior director, physician and ambulatory IT strategy. The ambulatory effort is part of a larger program called EHR Alliance to improve clinical care and workflows in all CHW settings, he adds. He describes it as an iterative process. “We try to remove barriers to adoption by continually rolling out functions and listening to feedback, then incorporating suggestions.”

Laura Jantos
Laura Jantos

Whyte notes that the growing publicity surrounding the medical home and ACO models is having an impact. “We were already having a good pace of adoption, but we have definitely seen heightened interest among physicians,” he says. “The physicians see integration as an economic reality, and CHW does, too. Many commercial insurers are going that way also. While there are still things to be worked out around HIE and ACOs, the CHW integration ship has set sail.”

As regional and statewide public HIEs slowly develop, the private HIEs like the one deployed by CHW are outpacing them because they are based on already established business relationships and don't require building consensus among competing stakeholders. Yet it is not at all clear what the longer-term role of private HIEs will be. The public HIEs stress their open architecture, but the private HIEs created by health systems are seen as an opportunity to tighten integration with physicians as a market advantage, notes Laura Jantos, principal of Seattle-based ECG Management Consultants. Another layer of complexity is that software vendors are starting to create HIEs for sharing amongst their customers. For instance, Epic Systems (Verona, Wis.) has developed a process for information exchange between providers known as CareEpic. These three wheels-public, private, and vendor HIEs-are spinning separately from each other, Jantos says, and it is not clear which models will win out.

Healthcare Informatics 2011 March;28(3):26-28

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