Whats the secret to the adoption of information technology in small physician practices? You could have learned the secret in a hard-to-find conference room at the conference. For two hours researchers under contract with the federal government presented the preliminary results of an economic model theyre building to predict physician practice use of IT.
It was an invitation-only presentation not listed in the official MGMA program guide. Only 50 attendees were invited; by our count, only 24 showed up. We didnt receive an invitation, but the door was open and there were plenty of empty seats.
Heres what we found out. HHS Office of the Assistant Secretary for Planning and Evaluation awarded an approximately $600,000 contract to a company called MDM Strategies based in Merritt Island, Fla. Rosemary Nelson, MDMs president and CEO, moderated the presentation. The HHS project officer overseeing the contract is Suzie Burke-Bebee, a registered nurse and senior health informaticist in the assistant secretarys office. MDM is working with two subcontractors to develop the predictive model of IT use by small physician practices, which the parties involved defined as having 10 physicians or less.
The first subcontractor is DecisionQ Corp., a data-mining and analysis firm with offices in Washington and Kentfield, Calif. John Eberhardt, a DecisionQ executive vice president, participated in the presentation as did Loretta Schlachta-Fairchild, president and CEO of iTeleHealth, the second subcontractor. Based in Frederick, Md., iTeleHealth develops a variety of telemedicine teaching tools.
The HHS contract runs from September 2006 through June 2008, with a final working predictive model due to the government by March 2008.
At the presentation, Eberhardt demonstrated the second version of the preliminary model to the two dozen attendees. Heres how it works. The researchers to date have identified what essentially are 113 variables that affect whether a small physician practice will buy, install and use an electronic medical-record system (See very complex chart). Some examples of variables are cost, physician demographics, payer mix, availability of IT training, specific EMR functions, etc. Some variables are more predictive than others, and various combinations of variables are even more so. The goal of the contract is to tell the federal government which variables to pursue and in what combinations to help achieve its stated objective of wiring up the entire healthcare system by 2014.
When we asked Burke-Bebee what recommendations she would make, based on what shes seen, to HHS Secretary Mike Leavitt, she referred us for comment to HHS Office of National Coordinator for Health Information Technology. Two days after the presentation, Leavitt announced a five-year demonstration project to provide financial assistance to up to 1,200 physicians in small- to medium-sized group practices to start using EMRs. Presumably, Leavitt didnt rely upon the test version of the predictive model to decide to create the new demonstration project because its not finished. Or did he? If he didnt, then why spend the $600,000 on a predictive model of physician IT use if youre going to ignore it and make decisions without it? If he did, theres more to this project than we know.
Burke-Bebee said, in classic bureaucratese, that the preliminary results from the model are confirming much of what we know. But theres a lot we dont know. In a follow-up exchange, though, she couldnt help but gush via e-mail, This is a very cool project.
And it is. The model, when finished, would be pure gold to anyone selling IT systems to physicians. It would tell them what series of buttons to pushexpensive systems but free trainingand whom to pushindependent practitioners or salaried physiciansto entice small practices to buy their systems. Same goes for anyone or any organization wanting doctors to adopt IT just because its good for patient care. But we cant help but think that the model will never see the light of day and will be filed away in some secure government computer system much like the fate of the ark of the covenant at the end of Raiders of the Lost Ark.
If that happens, it would be a shame. The model deserves to be part of the public record and made available to anyone who wants it. Taxpayers footed the bill, and patients ultimately would benefit from it.
Later on at the conference, a presentation by the Certification Commission for Healthcare Information Technology was about as exciting as one could expect for an IT program held in a windowless room in the late afternoon. CCHIT Chairman Mark Leavitt basically repeated the same presentation he has made before, but it was fun to hear him get somewhat combative when describing the reaction his organization receives. He noted that he has been treated like an enemy of the people, and that hes heard CCHITs electronic health-record certification process alternately described as too fast, too slow, too easy and too hard.
Its like stereo, he said, explaining that the feedback sounds just right when hes standing in the middle of it all.
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Partnership was also a core theme of the last session we attended. It was a presentation on how using nonphysician providersbasically, physician assistants and nurse practitionerscan enhance practice revenue and productivity. The presentation was given by Ron Nelson, president of Health Services Associates, a Fremont, Mich.-based practice-management consultancy, and a practicing physician assistant.
As a physician assistant, Nelson may be biased in his opinion, but he gave a convincing argument that the use of nonphysician providers has economic benefits for a practice. He predicted that their use will grow concurrently with the rise of pay-for-performance programs and the use of patient satisfaction as a quality indicator. Nelson explained that this is because these providers can handle the preventive care and disease-management tasks that pay-for-performance programs mandate and that patients will appreciate shorter wait times and better access to care.
A stumbling block to wider utilization of nonphysician providers can be the arcane web of state and federal laws regulating when and how they can be used and how much they can be paid. Knowledge is the key, Nelson said, because some insurers will balk at these providers offering things such as medical consultations, fracture care and especially mental health services.
Carriers will argue they cant, but where does it say that they cant? Nelson asked. He added that unless a state law specifically prohibits nonphysician providers from delivering these services, they can do so.
If there is any question over what services a physician assistant can provide, Nelson recommended people go to the summary of state laws and regulations posted on the American Academy of Physician Assistants Web site .
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