HFMA VIEWS

Healthcare IT issues were a dominant theme in this week’s news, beginning with President-elect Barack Obama’s weekly address highlighting investment in electronic health records (EHRs) as a feature of his economic stimulus plan. Later in the week, the National Conference of State Legislatures released a report showing a notable uptick in the number of health IT laws coming out of state legislatures over the past 18 months. Meanwhile, the National Alliance for Health Information Technology (NAHIT) published its own report indicating that tough economic times are taking a bite out of IT budgets at many providers.

As we approach the New Year, we also move into the season of industry forecasts for 2009. Not surprisingly, health IT figures prominently in these. PriceWaterhouseCooper’s Health Research Institute’s Top Nine Health Industry Issues in 2009 predicts an emphasis on technology in all of its healthcare manifestations, including online consumer health information sites, telehealth technologies, e-prescribing systems, and electronic health records. The Noblis Center for Health Innovation’s forecast of 2009 trends is a bit less sanguine. Echoing the NAHIT report, it predicts that capital expenditures for new technology that do not produce short-term gains for the bottom line will be scaled back, delayed, or cancelled.

In our own conversations with providers, we’re hearing that the lack of national standards for EHRs is an issue. Providers that have already begun investing in health IT indicate that the costs have been significant, but that patients are clearly benefiting from the investment. And while some savings are expected in revenue cycle and supply chain management, providers are looking to “soft savings,” which are more difficult to quantify, as quality outcomes improve.

In his January commentary for hfm magazine, nominated Office of Management and Budget director Peter Orszag cautions that health IT should not be viewed as a panacea for the problems in our healthcare system. But he also believes that a dramatically expanded health IT backbone is an essential step toward developing an effective, evidence-based, quality-driven system. Should the nationwide adoption of EHRs be a priority for health care? If so, what do you think will be necessary to achieve this goal? Share your thoughts by clicking on the “Comments” link below.

Healthcare reform proposals have been flying as thick and furious as the snow here in the Chicago area. Two of the stories in this week’s HFMA News--including the hfm magazine web exclusive commentary by nominated Office of Management and Budget director Peter Orszag and the story on America’s Health Insurance Plans’ reform proposal--discuss blueprints for reform. And as reported in today’s Wall Street Journal, nominated Health & Human Services Secretary Tom Daschle is urging “that Americans hold holiday-season house parties to brainstorm over how best to overhaul the U.S. health-care system.”

A holiday snowfall can make everything seem sparkling and bright, but when you get out the shovel, you realize that it is going to take a lot of work to clear the path. An op-ed in this week’s New York Times, for example, argues that a goal of universal coverage--achieved in part through expansion of state Medicaid enrollments--would drive demand for healthcare jobs, including expanded primary care positions for nurses and physician’s assistants. But this assumes that workers can easily move into these careers. As reported in this week’s news, America’s schools of nursing lack the capacity to address current and future nursing shortages. The American Association of Colleges of Nursing estimates that almost 28,000 qualified applicants were turned away from entry-level baccalaureate nursing programs in 2008 because of faculty shortages. And as reported last month, shortages of primary care physicians also loom.

The goal of universal coverage is also sure to raise issues for healthcare providers, especially if it is achieved through expansion of existing government programs such as Medicaid.  Margins for providers depend upon a payer mix, and an increase of Medicaid payments--at least as the program exists today--could adversely affect that mix.

It’s the season of excitement and miracles. But after the holidays pass, it’s time to take down the lights, get back to work, and look forward to shoveling a lot more snow. There's sure to be a lot of shoveling necessary to uncover the many issues affecting health care as a new Congress and a new administration try to determine the best path to reform.