Most parents attempt to instill in their children lessons that last a lifetime and advance their happiness and success. Mine did. One of the best lessons my father taught me, for use in business and social contexts, was to be aware of—and prepared to act—when the rules of the game change.
Most parents attempt to instill in their children lessons that last a lifetime and advance their happiness and success. Mine did. One of the best lessons my father taught me, for use in business and social contexts, was to be aware of—and prepared to act—when the rules of the game change.
Dad was a financial guy. One of his favorite examples was the IRS, the tax structure and changing rules about taxable income and capital gains. One of my favorite examples is the airline industry and thousands of employees who joined it in the 1980s, believing in the promise of six-figure pensions.
The rules of every game are subject to change and likely to change. The hard part isn’t making new decisions to move forward. The hard part is identifying who owns the game, remaining ever ready to change course in midstream and then knowing the right moment to do it.
When it comes to healthcare delivery, IT and automation adoption, providers are major players in a game that never stops changing. Once there was no Medicare; now there is. Once there was no such thing as a health benefit plan; then there was insurance. It included first-dollar coverage, followed by deductibles and coinsurance, and followed again by capitation and copayments. Now consumer-directed healthcare, high deductible plans and HSAs are all the rage. Same game, new era, new rules.
For the last several years, estimates about the percentage of physician practices that have adopted electronic charting, EMRs, e-prescribing and CPOE have varied from 10 percent to 25 percent. One thing is certain: e-anything isn’t steamrolling its way onto the landscape.
What can physicians believe that is constant and unwavering enough to warrant a large investment, both financial and personal, in clinical IT? The rules of their game are in constant flux. Nothing changes faster than what payers reimburse for, except maybe how much and when. Dr. David Brailer, last year’s meteoric star, will soon exit the building. What about the national health information network initiative with an EMR in every doctor’s office: Will the dream survive beyond 2008, or will the next administration lavish it with financial support? When it comes to flux, healthcare has the market cornered.
The healthcare world spins faster than a whirligig. While some pundits suggest that pay for performance is the fast track to nowhere, fixed-fee McMedic clinics staffed by APRNs spring up in Target and Wal-Mart, applauded by employers who incent workers to use them. Illegal aliens demonstrate for the right to use local services, healthcare among them, as if this were the United States of Massachusetts, or Hillary and Ira had succeeded 20 years ago. Exhausted by the business of healthcare, physicians forsake insurance and open boutique practices.
Be certain of this: When the rules change, the game does evolve into its next iteration. It doesn’t matter whether the game is provider reimbursement, EMR adoption or the U.S. tax structure. Not every physician practice that hasn’t leaped aboard the electronic bandwagon holds out based on IT aversion. Some slow-adopters are managed, I am sure, by practice managers with wise fathers like mine. They aren’t necessarily IT averse or resistant. Maybe they are just monitoring a landscape that changes so fast, it’s hard not to do a complete 360 and spit pea soup. Who could fault them for their caution and watchfulness?
