Measuring Healthcare Reform's Impact

As soon as President Obama signed the Patient Protection and Affordable Care Act into law in late March, CIOs, policy leaders and industry observers began trying to gauge its potential impact, as well as how it might relate to the HITECH Act’s meaningful use requirements.

“I have read the bill and it is complex to understand,” says David Muntz, senior vice president and CIO of the Baylor Health Care System in Dallas. “It’s kind of mind-boggling, but everyone is going to be impacted.”

Muntz, who chairs the CHIME Advocacy Leadership Team, says many of the reforms are valuable, but he adds that CIOs might initially have trouble translating the huge macro-economic proposals down to the environment of their individual facilities. “The challenge for me is making an accounting of the costs and benefits of reforms that are inter-enterprise.”

The day after the bill was signed, David Blumenthal, M.D., National Director for Health IT, told the Health IT Standards Committee of the federal Office of the National coordinator for Health IT (ONC) that he was moved by watching the bill-signing ceremony, and hoped the standards committee members felt invigorated by the reminder that their work is “front and center in terms of what the healthcare system needs to accomplish in the next five to 10 years.”

Although noting that some of the new law’s impact on health IT development may be indirect, Blumenthal said that its cost-saving assumptions include “that the work we are doing will enormously empower many aspects of the health system — administrative simplification, accountable care, quality measurement, the ability to coordinate care through medical homes, and the ability to create a primary care work force that is enabled to provide high-quality primary care.”

One key element of the healthcare reform bill is on quality reporting, and that really does build on the HITECH Act, says David Roberts, vice president of government relations at the Chicago-based Healthcare Information and Management Systems Society (HIMSS). The secretary of Health & Human Services is required to develop reporting requirements to improve health outcomes, he says, and HHS will have to determine where there are gaps in quality measures and focus on developing new measures to fill those gaps.

“CIOs will have to be aware that as they focus on the meaningful use stages, new quality reporting metrics will be coming down the pike,” says Roberts, who adds that the hiring of Donald Berwick, M.D., president and CEO of the Cambridge, Mass.-based Institute for Healthcare Improvement, to lead the Centers for Medicare and Medicaid Services sends a great signal that the focus will be on paying for quality rather than on paying for episodes of care.

Quality measures clearly play a central role in both the HITECH and health reform pieces of legislation, and many of the IT tools expected to meet reform goals are already being developed to meet meaningful use requirements. “CIOs will have to continue to develop the business analytics capabilities to produce these types of reports,” says Lynn Dunbrack, program director for provider/health payer research at Framingham, Mass.-based IDC Health Insights. Also, technology tools that help with the dissemination of best practices and evidence-based medicine will go a long way toward meeting some of the reform measure’s goals. As she wrote in a recent report on health reform, there is a natural progression from collecting and sharing data to creating guidelines, protocols and actionable advice that will enable cost reductions and better outcomes.

Pressure for greater efficiencyThe expected increase in the number of patients with insurance coverage will put pressure on providers to see more patients, Dunbrack adds. IT leaders will be tasked with finding innovations that give providers efficient ways to see more patients in the same amount of time. That may involve mobile technology, telemedicine, and online care.

Efforts to develop bundled payment pilot projects and coordinated medical home care will require new IT tools to both help understand the total cost picture and to allow providers to collaborate with others in the community, Dunbrack says. That might involve both physician and patient portals that can help with a focus on preventive care and patient self-care for chronic conditions. Pilot programs that allow hospitals, physician groups and other provider organizations to work together to manage a patient’s care may eliminate some legal barriers to care coordination, according to a recent essay by Rich Umbdenstock, president and CEO of the Washington, D.C.-based American Hospital Association. “Hospitals would welcome a leadership role in bringing these providers together,” he wrote.

The new law may require both the development of new systems and new roles for the CIO, noted L. Michelle Issel, Ph.D., R.N., editor-in-chief of the Health Care Management Review. In the April/June 2010 issue, she wrote that one provision is to reduce Medicare payments for preventable re-hospitalizations. To prevent re-hospitalizations, hospitals will need to develop more adept systems to monitor and prevent post-hospitalization complications.

Issel, who is also a clinical associate professor in the University of Illinois at Chicago’s School of Public Health, added that once new quality measures have been established, “having information and documentation systems that collect these measures will require chief information officers to be well connected to the sources that disseminate the new measures as well as those who will be documenting and analyzing the data. This may require some reorganization within the health care organization.”

While addressing many large issues around payment reform, the act also contains detailed health IT provisions on issues that many CIOs are likely already dealing with. For instance, it requires HHS to receive input on whether revisions should be made to the crosswalk between ICD-9 and ICD-10 that is on the Centers for Medicare and Medicaid Services' Web site. Likewise, calls for financial and administrative simplification build on efforts already under way.

Baylor’s Muntz says one major concern is the provision in the healthcare reform legislation that mandates an excise tax on biomedical equipment. Set to begin in 2013, the 2.3 percent tax is expected to raise $20 billion over the next 10 years.

“That 2.3 percent could have a huge impact on organizations already spending tens of millions on such equipment,” he says.

HIMSS’ Roberts says that many people have been overwhelmed trying to digest all the information in the bill, and many are not clear what is hype and reality about the legislation, but he believes it is going to have a “major positive impact.”

But even if it hadn’t passed, Roberts says, the momentum for health IT developments wouldn’t have abated.

“President Obama has made clear that in the movement toward universal coverage, they first had to lay the groundwork, which included interoperable health records,” he explains. “This is a building block process, so even if this bill hadn’t passed, the incentives in HITECH still would have laid the foundation and still would have been the priority for providers.”