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Wednesday, May 02, 2007

Who Should Pay?

Could a hospital justify subsidizing computers for its private practice physicians by claiming that doing so would facilitate the development of an electronic medical record? Or would it be considered a kickback for admitting patients to the hospital?

That has been an issue for some time now. Recently, a conflict has arisen between federal anti-kickback rules (the Stark law) and the federal policy of promoting the computerization of medical records (See “Stark Redo.” H&HN, February 07).

A major goal of computerizing medical records is to make information about the patient more readily available to whoever is caring for the patient. Thus, it would clearly be beneficial to include information from the office of the patient’s doctor. But that requires that the doctor’s office records be computerized and tied in to the hospital’s record. The question is who should pay for it? The doctor is understandably reluctant to pay for something that will mainly be of benefit to others. Hospitals are in many cases willing to pay as a community service, but are fearful that doing so will violate the anti-kickback laws.

This issue is another example of the problems created by the separation of the professional (e.g., physician) and institutional (e.g., hospital) components of our health care system.

The patient and his or her medical condition may be a single entity, but because of the way the system is organized, we have long treated the inpatient and outpatient phases of care separately. At one time, even hospitals that operated outpatient clinics (usually for the poor) kept their inpatient and outpatient records separately and I can remember when combining them was seen as a progressive development. The implications for duplication of effort and fragmentation of care are obvious.

As we move towards the redesigned health care system of the future, hospitals and doctors will combine into a single organization - a process that is going on as we speak. Progress in that direction will make it easier to resolve a number of issues, including who should pay for computers.

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