Taking the Good with the Bad: The Healthcare Community is Indeed Embarking On a Tumultuous Road Ahead

After a detailed conversation recently with a practicing physician, my long-held suspicions about meaningful use may be coming to fruition.

You see, though I’m a believer in meaningful use from a data collection perspective and for the benefits it provides the healthcare community in being better able to track outcomes and measure results, I’m also concerned with the amount of regulation and oversight required of the reform. Additionally, I’m concerned about how the overbearing amount of added reform is affecting the thousands of small businesses that are private practices.

With the added mandates and with the continual burdening requirements of the physician as educator to patients, there’s only so much room left for them to take on their tasks as caregiver.

All of that said there is some growing resentment in the healthcare community that suggests physicians are growing resentful of their educational assignment.

“Our job is not patient education,” the physician I spoke with said, asking that his name be withheld. “We’re on the precipice, teeter tottering on the verge of collapse and the system is going to fall down. We’re being pushed to the extreme with patients. We need to see more patients per hour just to cover our expenses because the margins have disappeared.

“We’re forced to focus on getting more patients through the door; we don’t have time to focus even more on patient care,” he said.

Besides meaningful use, there are other issues to address in healthcare, he said, like 5010, ICD-10, Medicare and Medicaid changes and insurance hurdles.

On top of these issues, physicians struggle with internal operations because of the financial cuts to their practices. With ever-changing reimbursement rates affecting the amount of money they can bring into their practices, practice leaders also have to worry about making payroll. Certainly, physician salaries are declining. Gone are the days when physicians were guaranteed lucrative careers.

The more likely model now will become the one where physicians become employees.

“Healthcare reform essentially is putting the private practice out of business,” he said.

In the long run, the only successful private practice model will likely come down to where large practices dominate the landscape. Anything less than a 300-physician group probably won’t survive, he said.

“This is the reality of what we’re seeing in the outside world.”

Add all of this to a physician shortage that’s only getting worse, and the healthcare community is indeed embarking on a tumultuous road ahead.

We Live In a Database World and No Matter How Meaningful We Use It, There’s Still Much to Be Desired

The meaningful use of data collected in an electronic health record continues to be the stump speech of Farzad Mostashari, National Coordinator for Health Information Technology.

He’s been pushing the message for months: those achieving or working toward meaningful use attestation need to get beyond just the financial incentives of the program, he says.

Physicians and their healthcare systems need to dig deeper and realize the importance of the data that they have at their hands. They need to realize just how to leverage the data to improve their patient’s health outcomes and lead those in their care down an educational path about the importance of their involvement in their care and how electronic systems can help improve their interaction with their care providers.

For meaningful use to work, those in the community need to make sure they’re using the data collected meaningfully. Meaningful use is a tool and it should be used as one; but unlike a simple jack knife, it’s a multi-purpose, multi-blade, do-it-all Swiss Army knife.

If used correctly, as a means for change rather than a singular solution for incentives, Mostashari believes that meaningful use can actually lead to population health management (the real reason behind meaningful use), more patient engagement (this is yet to be determined) and the creation of health information exchanges (yes, but we need interoperable systems before we see wide spread use of data outside their silos).

His ambitions are correct, and collectively, there is a fundamental agreement that meaningfully using EHRs will help accomplish all of these goals (though patient engagement may remain the stickiest of wickets). The problem here, though, seems to be that even though most physicians want to dive into the deep pool of big data, but they just don’t seem to be able to catch their breath.

In all walks of life we face the day-to-day grind of ongoing and seemingly never ending tasks that drive us further away from our goals. However, it’s different in healthcare. I just can’t seem to think of any other professional group (other than members of the military and police forces) under so much constant pressure to produce positive, long-term results for the people they serve.

In addition to making life and death decisions, our physicians and healthcare leaders are constantly facing the deluge of regulation and reform (meaningful use, ICD-10, HIPAA and even to a certain extend malpractice and 5010).

Healthcare professionals are overrun by details that have taken them into the weeds. Their days are long and their time is short. We can argue if electronic health records actually save them time and money. Depending with whom you speak, each person has an opinion as to its effect. Add everything I previously mentioned and it’s simply overwhelming.

I firmly believe that in a best case scenario, we’d be able to meet all of Mostashari’s proposed goals. Big data would (and can) lead to a changed system and provide real and personal stories of improved health outcomes. I believe that if we could clear away the clutter, we could begin building upon the foundation and create the best, most comprehensive, patient-serving healthcare system that produces results and actually changes lives.

But, for now, we live in a database world where no matter how meaningful we use them there’s still much left to be desired.