Thursday, April 30, 2015

Cost and Culture

I like aphorisms and one of my favorites is this – no hospital administrator ever got his portrait in the lobby for saving money.

That one has been apt for a long time and still is, but things seem to be changing.  Here are a couple of quotes from an editorial that appeared in the March 16 issue of Modern Healthcare:

“Over the past two years, conventional wisdom presumed without offering much in the way of evidence that the lingering recession and the rise of high-deductible and narrow network plans explained the slowdown of healthcare spending, now in its fifth year.”

“Indeed, most economists and the media echo chamber repeatedly said rapid spending growth would resume once the economy picked up steam.”

“But now, finally, the Mr. Joneses at the Congressional Budget Office have come around to admitting that something is happening here, even if they don’t know what it is.”

One possibility is that there has been a shift in the culture.  Somehow, public concern about cost, the inclusion in Obamacare legislation of cost-reduction measures, more aggressive tactics by insurance companies, the growth of so-called value based payment mechanisms and other factors seems to have made it acceptable for management to be more aggressive in pursuing cost reduction measures, even when that gores somebody’s ox.

Culture is a powerful thing and may someday even get a cost-reducing administrator’s portrait in the lobby.

Sunday, April 19, 2015


Interoperability is the fancy word used to describe the ability of computers containing electronic medical records (EHRs) to communicate with one another.

Interoperability is one of the main potential benefits of EHRs.  Making a patient’s medical information available to every doctor and hospital would be an enormous boon and make better care possible at lower cost.         

According to the April 13 issue of Modern Healthcare, some $29 billion has been spent under the Affordable Care Act (a.k.a. Obamacare) to promote the development of EHRs, a program that has emphasized interoperability.  Eleven years ago, President George W. Bush created the Office of the National Coordinator for Health Information Technology with a mandate to implement a “nationwide…interoperable health information technology infrastructure.”  But according to a survey conducted by the publication, only 11% of respondents claimed to have routine interoperability across the country – presumably with the rest of the 11%.  17% said they had interoperability within their individual states.

The April 17 issue of the New York Times carried an editorial on the subject, blaming the lack of interoperability on “transfers being blocked by developers of health information technology or greedy medical centers that refuse to send records to rival providers.”

It all seems to be a part of the whole EHR debacle.  In concept, the situation doesn’t seem to me to be all that complex.  To achieve interoperability, computers containing EHRs either have to be able to talk to each other or they have to be able to talk with a computer or a few computers that can talk to all of them.  That means there has to be some level of commonality among the EHR programs and once the basic structure is decided upon, that commonality would be defined and required to be included in all EHR programs and providers required to use it.

Maybe there is a good reason why that hasn’t been done, but I can’t imagine what it is.

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