The consensus of a panel of Chicago information technology experts last week was that funding for healthcare IT in a post-Bush era will come from a multitude of sources, including the federal government, which recently approved an IT subsidy, representing an ideological sea change.
The panel was organized by Beacon Partners, a Weymouth, Mass.-based healthcare consulting firm, and was moderated by Ralph Fargnoli Jr., its president and chief executive officer. Other panel members were Stephen Lieber, president and CEO of the Healthcare Information and Management Systems Society; Jane Horowitz, chief operating officer for the National Alliance for Health Information Technology; and Dan Michelson, general manager and chief marketing officer for Allscripts-Misys Healthcare Solutions, a vendor of electronic health-record and physician practice-management systems.
When Bush came out as the healthcare IT cheerleader in chief with his 2004 executive order creating the Office of the National Coordinator for Health Information Technology at HHS, he fiscally constrained the effort by also declaring ONCHIT could not assume or rely upon additional federal resources or spending to accomplish adoption of interoperable health information technology. That ideology was amended recently with the announcement by the CMS that it would help subsidize health IT for physicians through increased Medicare reimbursements.
The (federal) government wants to go in this direction, Michelson said of the CMS initiative. The fact that they put the incentive in place is stunning, he said, adding that the program is a terrific starting point.
But, Lieber said, We cannot expect the federal government to be the sole source of funding in this area. Payers and the states will step up to the plate, he said.
There were over 1,000 pieces of legislation across the states this year for health IT, Lieber said. And after several years of various approaches to healthcare IT development, and the attendant risks, there is some security for the states initiating these steps right now. HHS has financially supported the Certification Commission for Healthcare Information Technology, which was co-founded by HIMSS in 2004 and provides a common set of certification criteria for clinical IT systems. There has been much work done on developing common standards for interoperability as well. We have that security that starts with moving in a common direction.
There are limits to what states can do, however, Fargnoli warned. In Massachusetts, for example, a recent state law allocated $25 million to fund an e-Health Institute to promote a state health information exchange organization, he said, but the state also has a $1.5 billion budget shortfall. Even in a state the size of Massachusetts, $25 million is only going to take them so far.
Fargnoli, too, said, I think were going to see a combination of state, federal and payer money.
Fargnoli asked panelists what impact the current crisis in the financial sector and the broader threat of a recession might have on healthcare IT spending and whether technology adoption will be slowing over the next few years.
I would not be at all surprised to see some impact, Lieber said. Healthcare organizations see additional revenue being generated through diagnosis and treatment, but not transfer of data. The benefits of investing in technology are not as tangible, he said. And healthcare leaders tell Lieber the issue of access to capital is very much on their minds. In addition, public and private payers are slow making payments to providers while the cost of commodities and utilities are still rising.
Michelson said, in the current state, sure there is a challenge, but the healthcare IT industry is just going to have to do a better job of selling the benefits, of explaining what these technologies bring to an organization such as better coding, which will increase revenue and speed payments. Thats our charge as a group to make that message clear. That ROI is here today, of breaking even in seven or eight months.
Fargnoli asked whether federal health IT requirements will force new regulations, particularly in the areas of privacy and security regulations.
I dont think its an issue of mandating, Lieber said. While acknowledging privacy and security breaches do occur, Lieber also said, We need to be a little less emotional and a little more factual. Its an issue of culture. We have to change the way that employers might use health information if it is made available to them. Thats one of the problems with an employer-based insurance system. That is clearly one of the concerns that privacy advocates have, because people lose their jobs if that information is used improperly.
Horowitz agreed. Theyre so afraid of that combination, of employer and payer getting together.
What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.