I just wanted to follow up on the comments by economists Robert Reischauer and Eugene Steuerle regarding the savings attributable to health information technology. First, if adoption of health IT is merely to save money, or if we are pursuing health IT for the sake of health IT, we should all go home. The goal is to improve the quality and efficiency of healthcare and health IT is a tool to get there.We all understand that there are competing demands for healthcare resources, and if health IT frees up some from a reduction in inefficiencies, they will be used somewhere else. And anyone who can successfully attribute hard-dollar savings to health IT should win the Nobel Prize -- I'm just not sure if it would be in medicine, economics or theoretical mathematics. That said, my fear from this report is that coming from Reischauer, the vice chairman of the Medicare Payment Advisory Commission, these statements may jeopardize federal -- and by association state and even local -- funding for health IT projects. We are finally making real progress in moving our industry toward the 21st century, and I would hate to lose that momentum. Not that it should be fueled by unreasonable expectations, but I do hope that the comments are considered in their entirety. To that end, I would reverse Reischauer's order: "While the jury is still out on how much money will be saved, health IT will lead to significant improvement on quality -- and would lay the groundwork for a pay-for-performance program." Healthcare resources are spent overwhelmingly on the chronically ill -- where most pay-for-performance metrics focus. To the extent that health IT benefits the care of those with chronic diseases, we will see savings. We have all seen a flattening of Medicare (non-prescription) spending this year, and I am betting it is related to the affordability of maintenance drugs by some going generic and the implementation of Part D. We'll see if my theory holds. Why focus health IT on chronic diseases? Because, as famed bankrobber Willie Sutton would say, "that's where the money is!"
James GarnhamDirector of actuarial servicesGreater Rochester (N.Y.) IPA
$18.5 million boondoggleWasn't interoperability a key objective of this project? What did IBM do? From my vantage point they lectured us about the magic of a personal health record, not interoperability. John Loonsk talked about "What is under the water" in what was shown. I hope the Gartner Group will focus on that. My guess is that they find vaporware.
A. Scott HolmesChief executive officerHolmes GroupBryn Mawr, Pa. To submit a letter to YOUR VIEWS, click here . Please include your name, title and hometown.