Attempting to reform healthcare has always been a bit like the arcade game Whac-A-Mole. The last several decades are fraught with examples of efforts to contain costs that only resulted in other expenses popping up somewhere else.
With that in mind, it’s difficult to assess the eventual future of yesterday’s Republican proposal that aims to repeal the Affordable Care Act and replace it. As the nation’s Chief Executive has noted about a week ago, “Nobody knew healthcare could be so complicated.” Well, it is—it’s a multi-trillion dollar industry, with a wide range of provider types, labor and supply costs, and other expenses intrinsic to managing patients, institutions and financial transactions.
Trying to tease out what this iteration of the ACA repeal and replace exercise will specifically do to healthcare IT is a tough conversation, since it’s looking far downstream from where we are today. If healthcare reform is a marathon (and I’ll pick on the upcoming Boston Marathon, just six weeks away), we’ve barely crossed the starting line in Hopkinton. There are many miles to go to the finish line (and along the way, a few hills will be encountered where hearts may be broken).
Many organizations in the industry are dissecting the various components of the Republican plan, how they compare to the GOP-despised ACA law, and the long-term effects that each of the new provisions could have. The bill will be worked over by two House committees, and it’s not yet been scored by the Congressional Budget Office for its effects on the budget. What is looming ahead is a huge battle between conservative and moderate members of the GOP, as well as Democrats looking to thwart change. The Boston Marathon extends for 26.2 miles; no one knows how long this reform battle will take to resolve.
Beyond the political battle ahead, though, the extended period of uncertainty will doubtlessly take a toll on healthcare providers. Assuming the GOP can eventually agree on a final repeal/replace strategy, it’s still possible to generalize on how the changes will affect healthcare and, in turn, healthcare IT.
No matter what form reform eventually takes, the healthcare industry will feel the brunt of increasing pressure to reduce healthcare spending. In the current administration, health expenditures are now competing against military spending and infrastructure redevelopment programs. With an aging population, and the rest of the Baby Boomers retiring over the next 10 years, expenditures are likely to continue to rise. A fundamental shift in what healthcare dollars are meant to achieve is needed, and that’s the underlying basis of value-based care. If we can’t afford to just spend an unlimited amount of dollars, then we have to get more value—more health, more effective care—for the dollars that we do spend.
The value-based care experiment is fairly young and unproven in healthcare, with early results showing some promise. The information technology to support these initiatives is also promising, and IT will be absolutely essential in making any kind of value-based care system work, and improve over time. Everyone can at least theoretically agree that we need to move from just providing a bunch of services to sick people, to a system that provides valuable healthcare services that optimize health and effectively treat illness as early as possible.
But the prospects of shrinking revenue, and the cloud of uncertainty, don’t give providers the confidence to make the transition. Already, the healthcare industry is caught in the tragicomic situation of having one foot in each of two “reimbursement” boats that are inexorably drifting apart. The industry needs a vision for the transition and a plan to achieve it, and a willingness to tweak that plan as the experimentation continues. More partisan bickering won’t permit that.
From our coverage at HIMSS17, we didn’t really detect provider reluctance to invest in information technology—many HIT executives we spoke with say their organizations have an IT strategy in place, and the decision making and implementation process often stretches over many months. Over the course of the conference, we identified more pragmatic uses of IT to address real-world problems—providers now seem to have the technological acumen and tools to tackle new challenges posed by population health management, value-based contracts and more.
But margins are still tight for many organizations, particularly those in rural settings or offering care to underserved, underinsured populations. These are the organizations that are most at risk for getting caught in the political wash over a protracted fight about reform. Changing care models, and buying the IT to support those changes, will be challenging.
Here’s hoping that the politicizing will subside, for the sake of the entire healthcare industry, and the nation’s population that counts on providers for life-preserving care.
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