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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


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