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More on Technology and a Move to Opportunities

February 20, 2013

In last month’s article, we used a good deal of space talking about the expanding role of electronic data, particularly that of an Electronic Medical Record (EMR), in healthcare.  Two very valid comments we made by readers subsequent to the article.  First, it was pointed out that a practice can have the best EMR available but, if it cannot communicate with other providers, then there’s a problem.  Writing interfaces between systems, particularly competing systems or large to small systems can be costly and the practice often gets hit with it that cost.  While there are moves to have standard medical record formats, this interface issue will continue to hinder true electronic communications.  Without clear financial incentives to overcome this barrier, it will continue to hinder the move to a truly seamless and highly effective electronic medical record.

The second issue, highlighted by natural disasters both recently and in the past, deal with medical information security.  In this case the issue is not necessarily patient privacy.  Instead, it’s making sure a record survives a disaster.  Like insurance, a disaster recovery plan, can cost some money and may not ever be used.  However, the super storm Sandy issue in the northeast, Hurricane Katrina in New Orleans and localized storms and individual issues such as fires or floods, point out the need to have a good disaster recovery plan.  My years ago I had the experience of having a clinic destroyed by fire so I can attest firsthand the benefit of having an EMR. The use of and EMR is good, as long as there are regular backups that are tested on a regular basis and kept offsite (preferable not in a building close by).  Had this been the case when my clinic burned, we would not have had to rely on the side effect of records being stored so tightly on records shelving that we were able to painstakingly recover about 80% of the patient records.  Few things are worse than assuming you have a backup when the data really didn’t get backed up or a tornado that takes out an office and the facility across town where the backup is stored.

In other areas, The National Committee for Quality Assurance (NCQA) has announced a certification program for individuals or companies wishing to become certified in assisting providers interested in becoming a Patient Centered Medical Home (PCMH).  There are about 5,000 PCMH’s across the country and expectations are that this number will grow as more providers look to take advantage of opportunities in healthcare reform.  In addition, the NCQA recently announce plans to establish its Patient Centered Specialty Practice (PCSP) program.  The NCQA defines this program as focusing on specialists who strive to: 

  • Successfully coordinate care with their primary care colleagues and each other.
  • Provide timely access to care.
  • Improve communication with patients.
  • Measure performance and improve quality through continuous activities tailored to their practice’s specific needs.

It’s clear that significant focus continues to be placed on alternative delivery models like PCMH’s, PCSP’s, ACO’s and other shared savings, efficiency based delivery models.  These are in big contrast to the current Fee For Service (FFS) model which is transaction / volume based.  Making the change from FFS to these new models means, if shared saving are going to be attained, that someone is going to see their revenue go down.  That’s a tough pill to swallow but it’s an inevitable outcome as the battle to reduce healthcare costs continue.

Finally, the is significant increased focus on doing away with the Sustainable Growth Rate (SGR) factor used to establish the Medicare fee schedule.  Those reduction in costs we are starting to see have significantly reduced the cost of an SGR fix meaning it is likely some permanent fix can be achieved.  There are at least two proposals in currently in Congress to address this issue so providers may not have to deal with the annual guessing game related to the SGR and expectations are that we will finally see a real fix.

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