Here’s a conversation somebody should have had with an empty chair.
Let’s pretend the chair is U.S. Attorney General Eric Holder.
“You know, Mr. Holder, we pay doctors as if they're sewing shirtwaists in some sweatshop loft in New York's garment district in the 19th century. If they whip in some more-elaborate stitching, so to speak, we try to keep track of that and pay them a little more, but basically, we just pay them like pieceworkers.
“So, Mr. Holder, work with me on this analogy.
“Let's suppose, instead of making them sew (i.e., treat patients) the old-fashioned way, whipping in stitches (I mean documenting their work) with needle (pen) in hand, let's make them all get pedal-powered sewing machines (by that, of course, I mean electronic health-record systems).
“Old ways die hard, Mr. Holder, and the best of these machines are, admittedly, kinda clunky, but still, I think we can sell the docs on switching over to them by explaining that once they buy and install the machines and once they figure out how to use them, they should be able to crank out in a given day a lot more shirtwaists (by that, I mean patient visits).
“But this is the real selling point, Mr. Holder. With the machines, the docs' production of the more-difficult, intricately stitched shirtwaists (the more thoroughly evaluated patients) will jump. That'll be good for the patients and docs, particularly if we don't change the piece rate.
"So, the sales staffs of the machine vendors will sell the docs on the machines by saying they're gonna make a lot more money. It's brilliant.
“We can try this first as a pilot, Mr. Holder. Then, we'll toss in a few billion bucks for down payments on new machines. We'll get all that money back and more through the docs' increased productivity.
“But wait, just thinking out loud here: Won't we have to pay the docs more? Because once they get handy with these machines, they'll produce more, especially the higher-cost stuff.
“What's that, Mr. Holder? You've got an idea? Cut the docs' piece rate, right?
“No?
“What?
“Accuse the docs of fraud?
"Really?
“You're kidding, right?
“You'll come off like Claude Raines in Casablanca.
“Didn't we just tell the docs to use the machines?
“And what if this all comes down in an election year?
“OK, so you figure, it's a big country, someone will have to be using the machines up against the chalk lines. Right, and then you say, 'I'm shocked, shocked!' Just like Claude Raines. We'll have a couple of show trials and the docs will dial it down on their own.
“Beautiful!
“Do you really think it will work?
“Nah, me neither.”
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This year, it seems, the Healthcare Information and Management Systems Society is taking a more subtle approach to lobbying for privacy and security regulation.
During its annual Health IT Week lobbying push earlier this month, HIMSS presented just three "asks" to Congress. Two dealt with privacy and security issues.
One asked legislators to study patient identification. A two-page letter from HIMSS spent a lot of verbiage discussing the history of a national patient identifier and how Congress has, since 1999, banned federal funds from being used to "promulgate or adopt" one.
Nonetheless, HIMSS is looking for wiggle room.
Its statement pondered whether studying a patient identifier is verboten, then postulated that a "lack of clear congressional intent . . . poses a huge impediment to the optimal adoption of health information exchange."
That's a slight softening of focus. In 2006, HIMSS and another organization it helped create, the National Alliance for Health Information Technology, pushed for a national patient identifier.
In another "ask" this year, HIMSS is lobbying Congress to support "harmonization" of federal and state privacy laws—again, an apparent softening of its position.
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How long did it take American farmers to widely adopt hybrid corn?
Honestly, I don't know, but I do remember what I was told about that kind of adoption—30 years.
I was age 22 at the time and had just started my agriculture extension training with the Peace Corps in Sierra Leone, where we learned the basics of rice paddy construction and swamp rice cultivation. It wasn't until later, when we were posted to our villages to serve our two-year hitches, that we learned just how hard it was going to be to convince wary farmers to abandon their familiar but ecologically destructive slash-and-burn cultivation techniques.
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A million and a half dollars here, a million and a half dollars there, and pretty soon, you're talking real money—even in the healthcare industry.
The Office for Civil Rights at HHS on Monday announced a settlement agreement for $1.5 million with a venerable Massachusetts healthcare organization, Boston-based Massachusetts Eye and Ear Infirmary and its affiliated medical group, Massachusetts Eye and Ear Associates, over alleged HIPAA security-rule violations. They involve the reported theft of an unencrypted laptop bearing the records of 3,621 individual patients back in 2010.
I did a quick check of the OCR's "wall of shame" website and found MEEI was getting whacked on its second trip to the rodeo.
The privacy and security enforcers at the OCR, after a long, long period of quiescence, appear to be stepping up their enforcement efforts and availing themselves of the stiffer penalties that Congress provided in the American Recovery and Reinvestment Act's revisions to the Health Insurance Portability and Accountability Act's privacy and security rules.
And while the OCR is allowing MEEI to pay the fine on the installment plan, even $500,000 a year is a lot of money—a point not lost on MEEI itself.
In a statement, MEEI said that because no one appears to have been harmed, it was "disappointed with the size of the fine, especially since the independent specialty hospital's annual revenue is very small compared to other much larger institutions that have received smaller fines."
I'll bet.
But it's hard to know what the government was supposed to do other than to take out its proverbial 2x4 and start whacking to get the healthcare industry's attention.
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Sarah Krug, president of the Society for Participatory Medicine, had taken her stab at diplomacy before I spoke with her over the phone last week.
I had been reading news releases and calling people I know to put together a story about industry leaders' reaction to the massive, 1,354-page, three-rule phone book the feds dropped on the industry Aug. 23 and Aug. 24 when I received a hedged e-mail from Krug's group.
"Although we're disappointed this final rule does not give patients next-day access to their electronic medical record after they leave the hospital, we believe that on balance the Stage 2 meaningful-use requirements go a long way towards patient empowerment and feature a number of important patient-centered innovations," it said.
In a follow-up phone call, she was more direct: "Long story short, we're disappointed."
The goal of the New York-based not-for-profit, Krug said, is for patients to have immediate access to their updated records. They had been hoping for next-day access in the Stage 2 rule. Instead, the rule requires hospitals to make available online to more than 50% of their patients their information within 36 hours of discharge.
"It's definitely a step in the right direction,' Krug said, before adding, "I'm sure there are going to be a lot of patients that are going to be just as disappointed."
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