Jacobson09-10From the Chair

Catherine Jacobson, FHFMA, CPA

The carrot and the stick are in place.

Now that the Centers for Medicare & Medicaid Services and the Office for the National Coordinator of Health Information Technology have issued proposed regulations listing meaningful use standards, providers know what they must do to qualify for incentive payments in 2011-and avoid penalties that start in 2015.

Achieving meaningful use is significant, but it's only the first step in a longer journey to maximize meaningful value from IT. As Jason Fortin and Walt Zywiak point out in this issue of hfm, working toward meaningful use in a way that maximizes meaningful value from IT will benefit hospitals long after all the incentive funds have been spent. And that's the framework hospitals should use in considering IT investments. No regulatory carrots or sticks could warrant the IT investments hospitals and health systems need to make in the years ahead.

At Rush University Medical Center, we originally developed an integrated quality improvement program through our physician hospital organization (PHO) as a complement to our managed care contracting strategy. We believed the best way to prove our value to managed care companies was to provide an integrated quality improvement plan with demonstrated results. We launched the program using nurses to audit charts manually. Realizing that this process is inherently subject to error, we decided to build a data warehouse to take in data from our PHO members' disparate billing systems. This allows us to analyze our quality results more efficiently and systematically and expand our pay-for-performance (P4P) contracting. In addition, developing the underlying utilization and cost data has enabled us to understand the impact of our P4P contracts and the most effective way to distribute payments to PHO members, including hospitals, employed physicians, and private physicians.

Implementation of an EHR takes us to the next level. We have completed EHR implementation at our flagship hospital and have plans to achieve "one patient, one record" throughout our system. This means providing an integrated record to all our hospitals and employed physicians and providing a data link to our private physicians along with an opportunity to "buy in" to the integrated system. We are currently certified at stage 6 of 7 in the HIMSS EMR Adoption ModelSM, reflecting our high level of EHR capabilities.

Our EHR accomplishments ensure that we won't incur any future Medicare penalties. But this is more than just a defensive strategy. We began this journey long before the HITECH Act was announced. The HITECH incentives, though helpful, don't come close to covering the entire investment. And the investment must be made before the incentive payment can be received.

Rush views these IT investments as a key strategy for remaining a top performer in terms of quality outcomes and performance improvement. The return on this investment will be realized as we mine the data, integrate our analyses with PHO data, develop new ways of communicating with providers and patients, and track the improvements in clinical quality outcomes. This is the approach we're taking to maximize meaningful value from our IT investments. Beyond the incentives and the penalties, it's an investment we can't afford to pass up.

Publication Date: Monday, February 01, 2010

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