November 23, 2009
Where Meaningful Use Should Be Focused
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“”Meaningful Use” should be linked to those two things (cutting costs and better care).” -Russ Reese in the comments.
The above assertion about Meaningful Use was made in the comments and I was kind of struck by it when I first read it. What should be the components of meaningful use?
A doctor perspective:
A doctor wants the EMR to make them more efficient, more effective, increase reimbursement, lower their costs and provide their patients better care.
A patient perspective:
A patient wants an EMR to provide them better care, lower the cost for services and maintain their privacy.
A government perspective:
The government wants an EMR to lower healthcare costs, improve patient care, and provide data to lower Medicare/Medicaid costs.
I may have missed a few motivations and the order changed, but I think this is the essence of what these stakeholders want from an EMR. Can these three different perspectives be married in a way that use of an EMR is meaningful to all of them?
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I think all of those things fit together. The funny thing about the cost savings is that every stakeholder envisions themselves as the beneficiary of that one. In truth, it may be the american tax payer that benefits (hopefully).
I guess this is on a lot of peoples minds – http://www.healthdatamanagement.com/news/meaningful_use-39399-1.html?zkPrintable=true
HHS has not provided much in the way of details as to how exactly meaningful use will be monitored so everyone is wondering how they will do it and making suggestions. The MGMA suggestions sound logical to me.
Russ,
It’s uncanny how similar their second recommendation is to what I suggested in this comment yesterday: http://www.emrandhipaa.com/emr-and-hipaa/2009/11/20/study-shows-little-benefit-from-emr-in-hospitals/#comment-121484
Looks like we’re on the same page for the most part. Too bad someone will feel bad if they go that simple since it will undermine all the work of the committee that put together that difficult to understand matrix;-)
Let me put these three perspectives in a more ruthless manner, since money drives the world and all.
A doctor perspective:
A doctor wants to make more money and see fewer patients. (More time for golf and cocktails).
A patient perspective:
A patient wants “that pain to go away” without filing for Chapter 11.
A government perspective:
The government does not want to spend tax dollars for the care of taxpayers (and sometimes non-payers).
And allow me to add a fourth perspective.
A vendor-lobby perspective:
Money!
Now how do we fit an EMR into all of this? Well, let’s try to see who will benefit the most from a nation wide implementation of EMR.
The Government will surely be able to spend less by reducing insurance payments. They will penalize doctors who do not comply with meaningful use. Fewer (but more meaningful) diagnostic procedures mean less payout by the government. Doctors end up making less and being sued more. Government saves a ton of tax dollars. Do you get tax cuts or returns? Probably not.
The Doctor will pay anywhere between $100-250K for an EMR. He will be able to see fewer patients (at least for the first 6-10 months) because of the “implementation phase” and learning curve. He might fire one of the front-desk girls who makes around $25K a year only to hire an IT administrator for $40k a year to maintain the newly bought system. Or he might end up paying a similar amount to the vendor for annual tech support. Still he will have to change the way he practices medicine, learn to type and try to see more patients to pay for the system’s upkeep. Hopefully, the doctor will get together with other doctors and lobby the government for higher co-pays or higher reimbursement for “meaningfully performed procedures” just to make ends meet.
The patient will still get sick with a throat infection as he usually does and go to see the doctor. He will still have to wait for an hour to see the doctor because the EMR enabled the doctor to see more patients and three others are waiting before him. He will probably pay $30 for co-pay while before he only used to pay $20. The doctor might not order an additional test to confirm Strep throat but will ask the patient to come back next week for a routine A1c to make sure he complies with meaningful use and several other regulations.
The vendors will happily sit back and enjoy the continuous stream of money coming in. The larger ones will be happier to get their money back for the investments they made during election campaigns. Several new healthcare IT vendors will make the Fortune 500 list.
Morals of the story:
1. Money makes the world go round.
2. The rich get richer, the poor get poorer.
And I am Nostradamus … :)
Jawad,
I’m not quite the pessimist that you are, but I do think that MONEY is a huge motivating factor and is often missed/forgotten/left out in many of the plans by government to get doctors to adopt EMR software. This is a huge mistake.