"Plus ça change, plus c’est la même chose"… Or Perhaps Not?

April 10, 2013
Amid the swirl of the HIMSS12 conference held Feb. 21-24 at the Venetian Sands Expo Center in Las Vegas, it was impossible not to get caught up in the frenetic whirlwind of energy that is the HIMSS Conference every year. But I was left wondering whether in fact, with impending federal mandates coming out of healthcare reform, and with the release of the meaningful use Stage 2 proposed rule, our industry might in fact now have reached a key inflection point.

Amid the swirl of the HIMSS12 conference held Feb. 21-24 at the Venetian Sands Expo Center in Las Vegas, it was impossible not to get caught up in the frenetic whirlwind of energy that is the HIMSS Conference every year. All of us—whether healthcare and healthcare IT leaders, vendors, consultants, industry analysts and observers of various types, journalists, or of any other possible category of attendee or participant—find ourselves pulled into the unique HIMSS Conference vortex each time it comes around; and on a human level, that’s absolutely understandable (if not unavoidable).

Still, amid all the activity and buzz, the French phrase, “Plus ça change, plus c’est la même chose”—the more things change, the more they stay the same—came to my mind more than once, and made me wonder whether in fact, with HIMSS12, and particularly with the release of the meaningful use Stage 2 proposed rule, our industry might have reached a very key inflection point.

Here’s the thing: for years—decades, really—we’ve had a rather curious situation, in which a small number of pioneering patient care organizations have been speeding ahead of everyone else, and making progress in every crucial area demanding change in healthcare—improving patient safety and care quality, enhancing clinician effectiveness, controlling costs, creating far greater accountability and transparency, and leveraging information technology to facilitate all those goals; while the broad majority of patient care organizations have until now for the most part lagged behind, for whatever reason or reasons.

And even as the pioneers and their cousins, the early adopters, have been engaging very aggressively in clinical transformation and in the transformation of all of their key care delivery and operational processes, a significant proportion of their fellow hospitals, medical groups, and integrated health systems, have hung back, remaining stuck in their operational stasis, and unable (and perhaps, in some cases, also more than a little bit unwilling) to begin moving down the path to transformation.

Now, however, those patient care organizations that have not yet made significant progress are faced with a range of federal mandates, certain to be backed up by copycat mandates from private payers—that will simply no longer allow hospitals and physicians to maintain the status quo.

Think about it: there are three very important mandatory programs that the Affordable Care Act has mandated via the Medicare program, and which are set to cut provider reimbursement for substandard performance, in the next few years—the avoidable readmissions reduction program, the healthcare-acquired conditions reduction program, and the value-based purchasing program—with only that third program offering the potential for payment increases as well (for high-performing organizations). Then there are the two big voluntary programs under healthcare reform: the accountable care organizations shared savings program, and the bundled payments shared savings program, both also under Medicare.

And, for our core healthcare IT leadership audience, there remains, looming above everything else, the meaningful use process under the HITECH Act, which, like the first three healthcare reform-driven programs mentioned in the paragraph above, is mandatory, and involves reimbursement cuts down the road for some provider organizations. Plus, of course, there is the required transition to the ICD-10 coding system, which, even with its announced temporary delay, will be compelling all providers forward in the near future along that dimension.

So those organizations not at the front of the pack, or even closely behind the front of the pack, are faced with a veritable tsunami of challenges; and unfortunately for them, it’s a tsunami that could literally prove fatal to their organizations over time, if they don’t begin to move forward on all of these fronts, at least the mandatory ones. As Jane Metzger and Erica Drazen of CSC have articulated to me through their articulation of their team’s studies and white papers over the past year, over the next several years, the reimbursement cuts coming out of the readmissions reduction, healthcare-acquired conditions, and value-based purchasing programs under Medicare could eventually total as much as 9 percent of Medicare annual payment, for hospital organizations in the lowest quartile in all three areas. And as we all know, for most hospitals, a 9-percent overall Medicare pay cut could be terminally devastating. And that doesn’t even count the anticipated reimbursement cuts for hospitals that fail to meet meaningful use by 2015.

Now where the proverbial rubber really meets the proverbial road, I’ve found over and over in my reporting over the years, is along the critical dimension of culture. In all the interviewing I’ve done of healthcare leaders over the past 22-plus years in healthcare, it’s become crystal-clear to me that patient care organizations with the right types of leadership and culture have consistently been those that not only survive change, and more specifically, payer and purchaser demands, but also thrive, in change-driven environments.

So what does this mean for the organizations currently behind the curve in terms of the care delivery transformation now being demanded of providers on a nationwide basis? If anything was clear at HIMSS12, it was that our industry is hurtling forward at an unprecedented rate of change. And, I would add, that operational stasis is no longer tenable.

Fortunately for everyone, it is at gatherings of all sizes, from the gargantuan scale of the HIMSS Conference, to the far more intimate and interaction-facilitating scale of the second annual Healthcare Informatics Executive Summit, that all of us in this industry will learn from each other in ways that will help everyone move forward together, not just because it’s absolutely the right thing to do, but, let’s face it, because we no longer have a choice.

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