Healthcare Matters

The “80/20 rule” is a rule of thumb in business that says a relatively small group (20%) is generally associated with producing the vast majority (80%) of transactions that are of interest. But regardless of how time tested that rule genuinely is; if we’re not careful, it can lead us to fundamentally flawed decisions. For example, in a supply chain context, 20% of the categories that providers may worry about as being too difficult to competitively source (e.g. PPI) may be as much as 80% of that provider’s addressable spend. Providers that invested in “platforms” designed to address “the 80%” typically made that discovery the hard way.

When it comes to the “meaningful use” EHR incentive payment program that has been causing quite a stir, we’re learning that the same old 20% –the richest and most sophisticated health systems in America—are the ones getting all the money. Ironically, I recently ran a post talking about how the Electronic Health Records (EHR) program seems to be working; how the incentive payment program is, in fact, having the desired affect.

Was I wrong? We’re now running up against $5 billion in total payments to date. That’s about 100 new hospitals per month qualifying and receiving payments and about 9,000 physician practices per month doing the same and getting their share. Not bad, but as said, it’s been discovered that those funds are finding their way to the same old 20% that always seem to come out ahead. It’s argued that the rich keep getting richer. But what percentage of America’s patient population is being covered by the 20% that’s getting all the money.  Can you guess?  Would you be surprised to learn that the five most populous states in the US are also where most of the recipient providers are located? The fact is, I haven’t been able to find a definitive answer, but no one is arguing that the number isn’t higher than 50%.

In the interim, and for those of you reading this post who work for an organization that is struggling with achieving the “meaningful use standard,” here’s some good information:

To qualify for “meaningful use” incentive payments, the following check list is non negotiable:

• Use computerized physician order entry (CPOE);
• Implement drug-drug and drug-allergy interaction checks;
• Generate and transmit permissible prescriptions electronically;
• Record demographics;
• Maintain an up-to-date problem list of current and active diagnoses;
• Maintain active medication list;
• Maintain active medication allergy list;
• Record, chart changes in vital signs;
• Record smoking status for patients age 13 or older;
• Implement one clinical decision support rule;
• Report ambulatory clinical quality measures;
• Provide patients with an electronic copy of their health information, upon request;
• Provide clinical summaries for patients for each office visit;
• Demonstrate capability to exchange key clinical information;
• Protect electronic health information.

Seem daunting? If you find yourself debating the pros and cons of a client server versus cloud-based solution, then stop now. It’s not a debate. There are, in fact, legitimate reasons why certain providers require a client server based solution. But if you’re a provider and don’t already know those reasons –if you’re not locked into a client server solution for some reason– then there really isn’t a tough decision here. Go for the cloud. Every list of “pros and cons” makes the business case for selecting a cloud-based solution. Save yourself the time.

There’s a lot of money being left on the table right now.  And it would be better if the traditional “have nots” would hurry up and get with the program. Turnkey, hosted solutions abound. The biggest “gotcha” I’m hearing about concerns misrepresentations by fringe vendors whose systems don’t accommodate the need for individual providers to mine their own data to make sure that a) the solution meets the “meaningful use” standard by b) providing an accounting of disclosures to patients. This aint rocket science folks. Reasonable due diligence (i.e. securing a reference from a provider who has been paid) is just common sense.

—Tom Finn