Healthcare Reform Law: A Gamble on the Future for Healthcare Executives

As is always the case with politics, what was certain in March is now a gamble as our government struggles to figure out who and what they should be. The latest elections have brought Republicans back in control of Congress; already it is evident that the primary goal of their new agenda is to repeal the healthcare reform law. Rather than argue for one side or the other, this article aims to point out the issues and turmoil surrounding the debate.
Currently, healthcare providers are caught up in a flurry of activity with system upgrades and changes in the way they do business and provide patient care. While improving patient care is always a good thing, it’s hard not to feel like we’re running around waiting for the floor to fall out from underneath. Providers are spending millions of dollars to upgrade their infrastructure, systems, processes and people to accommodate the digital age and new requirements but are still waiting to see if they will receive the promised incentives. President Obama and the Senate, still Democrat-controlled, will most certainly veto any challenges to the law as it is today. However, does that mean there won’t be negotiated changes or appropriation cuts in the law? And what happens in 2012 when President Obama’s first term ends? Bitter partisan and ideological war is far from over, and ongoing battles threaten to undermine it.
Keep in mind that twenty-one states are challenging the law in court on constitutional grounds. Voters in at least three other states are weighing ballot initiatives opposing it. The Republicans announced their new agenda yesterday, “A Pledge to America,” which calls for a repeal of the law, replacing it with a scaled-down list of provisions. While these are good provisions, they are not nearly enough to bring the industry to the 21st century in business. I applaud the efforts made to better the industry infrastructure and investment in order to improve the quality of care, however the current instability will do more damage than any good that has already been accomplished.
It’s one thing to develop incentives that will motivate healthcare providers to implement better systems and tools. It’s another to demand regulatory and compliance requirements when there is so much uncertainty surrounding the law. This environment is creating misgivings about migration, as executives have to gamble on what the future holds for their organizations.
There are many reasons to be concerned with the trajectory of the healthcare reform law, but what concerns me is what the debate is doing to the quality of the “enhancements” the law calls for. CPOE, a requirement under ‘Meaningful Use,’ is not a process you want to rush. It takes careful design and integration across multiple modules, applications and business areas. It also is the glue to the provider’s operations and automation. With such a rushed deadline for achieving ‘Meaningful Use,’ it sets the stage for large number of failures in achievement. There is not enough expertise to support the time frame so providers are moving forward to get something in place without ensuring there are adequate resources for a successful implementation. In addition, many organizations are using EHR’s for the first time; the combination of these two projects and all of the intricacies involved makes for a daunting task.
Studies indicate nearly half of CPOE systems in place are not achieving the results intended and now we are rushing the rest through without any real plan to make it happen as an industry. CPOE is not an electronic version of a paper-based system; therefore, it requires proper integration and numerous adjustments. This doesn’t include changes in clinical and business processes or adding functionalities to improve patient care. CPOE is an opportunity to identify problems in the execution of care and business operations, but it takes time to identify and work through these improvements.
For example, if you implement CPOE blindly it has nothing to do with assisting physicians with decisions about medication ordering. However, there are numerous ways that CPOE can facilitate ordering that require alterations to and customization of the ordering process. These are design decisions that need to be made early in the process and require some knowledge and experience prior to any build work. This is experience that is not readily available due, in part, to the low supply of knowledgeable resources because of the increase in demands for them.
I encourage our politicians to come together and find ways to cooperate, as our industry needs to give our providers the best chance to succeed. We also need a much clearer vision of what healthcare should look like in the future. Having worked in system implementation for years, the first question we ask our clients is, “do you have a unified vision?” We know that without it, the chances of success are very low. Our politicians need to add to our ability to succeed, not create the issues that derail us.

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