Emerging HIT Incentive Programs: Physician Responses

Transcription

1 Emerging HIT Incentive Programs: Physician Responses Health Information Technology Summit March 8, 2005 Peter Basch, MD Medical Director, ehealth MedStar Health David Kibbe, MD Director, AAFP s Center for Health Information Technology

2 Bio s Peter Basch, MD General internist Medical Director, ehealth MedStar Health Co-Chair PEHRC Co-Chair of the Small Practice Workgroup of ehi David C. Kibbe, MD, MBA Family physician Director, Center for Health Information Technology Co-Chair PEHRC Co-Chair of the Small Practice Workgroup of ehi Slide 2 Discussion Document Page 2

3 Overview Barriers to HIT adoption Why are incentives necessary? Responses to key HIT incentive programs Slide 3 Discussion Document Page 3

4 Risks / barriers to HIT adoption? Physicians are not computer phobic Physician culture is pro-quality / safety Computers are affordable / reliable Connectivity is affordable / reliable Software is reliable, and often affordable Why haven t physicians accelerated adoption of HIT? Risks / barriers to adoption Risks / barriers to interconnectivity Questionable (negative to very negative) business case Slide 4 Discussion Document Page 4

5 Slide 5 Discussion Document Page 5 Lowering Risks / Barriers to EHR Adoption High prices Barrier Confusion about product and company Not knowing which EHR is best for which type of practice Risk of implementation failure Wide variability in contracting and business practices Difficult and expensive access to external information Solution EHR product certification Trusted specialty-specific EHR guidance Affordability and transparency Trusted technical advice Standard contracting language, RFP guidance Standards-based solutions for labs, imaging centers, etc Current Work Certification Commission on HIT (CCHIT) AAFP, ACP, other medical specialty societies; KLAS, HIMSS, others Buying collaboratives - Medical professional and specialty societies AAFP s CHiT, ACP s PMC, QIOs AAFP s Partners for Patients, ACP s PMC ehealth Initiative California Health Care Foundation, ehealth Initiative

6 Slide 6 Discussion Document Page 6 Lowering Risks / Barriers to EHR Adoption High prices Barrier Confusion about product and company Not knowing which EHR is best for which type of practice Risk of implementation failure Wide variability in contracting and business practices Difficult and expensive access to external information Solution EHR product certification Trusted specialty-specific EHR guidance Affordability and transparency Trusted technical advice Standard contracting language, RFP guidance Standards-based solutions for labs, imaging centers, etc Current Work Certification Commission on HIT (CCHIT) AAFP, ACP, other medical specialty societies; KLAS, HIMSS, others Buying collaboratives - medical professional and specialty societies AAFP s CHiT, ACP s PMC, QIOs AAFP s Partners for Patients, ACP s PMC ehealth Initiative California Health Care Foundation, ehealth Initiative

7 Slide 7 Discussion Document Page 7 Lowering Barriers to Interconnectivity Barrier Solution Current Work Information overload Information out of context Care confusion Potential for duty and risk in an interconnected environment Potential for duty and risk with use of clinical decision support

8 Slide 8 Discussion Document Page 8 Lowering Barriers to Interconnectivity Barrier Solution Current Work Information overload Information out of context Care confusion Potential for duty and risk in an interconnected environment New clinical protocols for interconnectivity Dialog and clarity with legal / policy communities Potential for duty and risk with use of clinical decision support Dialog and clarity with legal / policy communities

9 Slide 9 Discussion Document Page 9 Lowering Barriers to Interconnectivity Barrier Solution Current Work Information overload Information out of context Care confusion Potential for duty and risk in an interconnected environment New clinical protocols for interconnectivity Dialog and clarity with legal / policy communities CCR??? Potential for duty and risk with use of clinical decision support Dialog and clarity with legal / policy communities???

10 Slide 10 Discussion Document Page 10 Creating the Business Case Barrier No money available for IT investment Questionable business case for IT adoption Negative business case for quality Negative business case for information management Solution Access to capital Pay-for-IT use Pay-for-performance Pay-for-activities of information management Current Work ehealth Initiative Financing Working Group National Group for the Advancement of HIT National Group for the Advancement of HIT, ehi, DOQ-IT, BTE, Leapfrog National Group for the Advancement of HIT, ACP, BTE, CCIP, CMHCB

11 Slide 11 Discussion Document Page 11 Creating the Business Case Barrier No money available for IT investment Questionable business case for IT adoption Negative business case for quality Negative business case for information management Solution Access to capital Pay-for-IT use Pay-for-performance Pay-for-activities of information management Current Work ehealth Initiative Financing Working Group National Group for the Advancement of HIT, ACP National Group for the Advancement of HIT, ehi, DOQ-IT, BTE, Leapfrog National Group for the Advancement of HIT, ACP, BTE, CCIP, CMHCB

12 Slide 12 Discussion Document Page 12 Creating the Business Case Barrier No money available for IT investment Questionable business case for IT adoption Negative business case for quality Negative business case for information management Solution Access to capital Pay-for-IT use Pay-for-performance Pay-for-activities of information management Current Work ehealth Initiative Financing Working Group National Group for the Advancement of HIT, ACP National Group for the Advancement of HIT, ACP, ehi, DOQ-IT, BTE, Leapfrog National Group for the Advancement of HIT, ACP, BTE, CCIP, CMHCB

13 Slide 13 Discussion Document Page 13 Creating the Business Case Barrier No money available for IT investment Questionable business case for IT adoption Negative business case for quality Very negative business case for information management Solution Access to capital Pay-for-IT use Pay-for-performance Pay-for-activities of information management Current Work ehealth Initiative Financing Working Group National Group for the Advancement of HIT, ACP National Group for the Advancement of HIT, ACP, ehi, DOQ-IT, BTE, Leapfrog National Group for the Advancement of HIT, ACP, BTE, CCIP, CMHCB

14 No money available For physicians access to loans is not a problem But willingness to borrow money for an uncertain ROI is. Nevertheless may be important for some doctors Slide 14 Discussion Document Page 14

15 Case for IT adoption (per( se) Successful IT adoption by itself has not been shown conclusively to improve quality or safety (except where quality has been specifically incented) Without further specifying process / outcomes measures as a requirement of reimbursement it is clear that HIT will be used to further the existing business case = volume and right coding Slide 15 Discussion Document Page 15

16 Slide 16 Discussion Document Page 16 The business case for quality and information management Computers are affordable Networking is affordable Broadband is affordable EHR software is affordable Interconnecting to all necessary sources of information is affordable

17 Slide 17 Discussion Document Page 17 The business case for quality and information management Computers are affordable Networking is affordable Broadband is affordable EHR software is becoming more affordable Interconnecting to all necessary sources of information will hopefully become affordable (perhaps free) and may (if we are lucky) improve quality and safety, and not result in information overload, cookbook medicine, and/or care confusion Quality care = (information) (knowledge) (context) Quality care = micro-tasking Quality care = time, cost, complexity Activities of quality care = the above, and population and disease management, non-visit based care, and care coordination

18 Slide 18 Discussion Document Page 18 Basic EHR

19 Slide 19 Discussion Document Page 19

20 Slide 20 Discussion Document Page 20

21 Slide 21 Discussion Document Page 21

22 Slide 22 Discussion Document Page 22

23 Slide 23 Discussion Document Page 23

24 Slide 24 Discussion Document Page 24

25 Slide 25 Discussion Document Page 25

26 Slide 26 Discussion Document Page 26 Decision support for patient

27 Slide 27 Discussion Document Page 27 Integrated registry proactive use by clinicians and staff

28 Slide 28 Discussion Document Page 28 Advanced EHR + Registry + evisits

29 Slide 29 Advanced EHR + Registry + evisits + HIE Discussion Document Page 29 PCPs and Specialists Long-term Care Home Health Community Hospitals Tertiary Care Hospitals Patient info Visit list Prob list Med list Allergy List Discharge Sum ED Reports CCR Patient info Visit list Prob list Med list Allergy list CCR Security / MPI CDE Reports Images Med lists Formulary Labs PBMs Imaging Centers Payors Diagnosis Claims History Eligibility Referrals Authorizations Claim Submission Claim Status Claim Remittance Decentralized model Personal Health Record Patients Bio-surveillance Safety, quality, efficiency indicators Public Health Outcomes Measures

30 Slide 30 Discussion Document Page 30 The business case for quality and information management Computers are affordable Networking is affordable Broadband is affordable EHR software is becoming more affordable Interconnecting to all necessary sources of information will hopefully become affordable (perhaps free) and may (if we are lucky) improve quality and safety, and not result in information overload, cookbook medicine, and/or care confusion Quality care = (information) (knowledge) (context) Quality care = micro-tasking Quality care = time, cost, complexity Activities of quality care = the above, and population and disease management, non face-to-face care, and care coordination

31 Slide 31 Discussion Document Page 31 Existing P4P initiatives Pros Cons Free software / devices Paid ecare Use of administrative data for P4P Use of administrative + clinical data for P4P = bad, to = completely meets goals

32 Slide 32 Discussion Document Page 32 Preferred P4P initiatives Pros Cons Care coordination / management fee Paid ecare* Staged pay-for-use data submission performance = bad, to = completely meets goals

33 Summary There are many risks and barriers to HIT adoption that can and should be lowered Interoperability only sets the stage meaningful clinical interconnectivity will determine its value Payers must create a sustainable positive business case for adoption and optimal use (recognizing the implications to the practice) HIT adoption per se may add little or no net cost to a practice, and may produce little or no net value for the patient may require a jump-start, but will not require ongoing incentives Integration of HIT into some practice settings can lead to quality/safety/efficacy/access ( HIT value), and doing so will provider time/cost/complexity ( practice costs) requires ongoing structural reimbursement changes Incentives should not just be based on numerical targets, as healthcare transformation enabled thru HIT includes other key elements, such as meaningful care coordination / management, collaboration with patients, and optimal use of non face-to-face care (none of which will occur without fundamental reimbursement reform) Slide 33 Discussion Document Page 33