Emerging HIT Incentive Programs: Physician Responses

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Emerging HIT Incentive Programs Physician
Responses

• Health Information Technology Summit
• March 8, 2005
• Peter Basch, MD David Kibbe, MD
• Medical Director, eHealth Director, AAFPs
  Center for MedStar Health Health Information
  Technology

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Bios

• Peter Basch, MD
• General internist
• Medical Director, eHealth MedStar Health
• Co-Chair PEHRC
• Co-Chair of the Small Practice Workgroup of eHI

• David C. Kibbe, MD, MBA
• Family physician
• Director, Center for Health Information
  Technology
• Co-Chair PEHRC
• Co-Chair of the Small Practice Workgroup of eHI

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Overview

• Barriers to HIT adoption
• Why are incentives necessary?
• Responses to key HIT incentive programs

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Risks / barriers to HIT adoption?

• Physicians are not computer phobic
• Physician culture is pro-quality / safety
• Computers are affordable / reliable
• Connectivity is affordable / reliable
• Software is reliable, and often affordable
• Why havent physicians accelerated adoption of
  HIT?
• Risks / barriers to adoption
• Risks / barriers to interconnectivity
• Questionable (negative to very negative)
  business case

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Lowering Risks / Barriers to EHR Adoption
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Lowering Risks / Barriers to EHR Adoption
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Lowering Barriers to Interconnectivity
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Lowering Barriers to Interconnectivity
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Lowering Barriers to Interconnectivity
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Creating the Business Case
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Creating the Business Case
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Creating the Business Case
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Creating the Business Case
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No money available

• For physicians access to loans is not a
  problem
• But willingness to borrow money for an uncertain
  ROI is.
• Nevertheless may be important for some doctors

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Case for IT adoption (per se)

• Successful IT adoption by itself has not been
  shown conclusively to improve quality or safety
  (except where quality has been specifically
  incented)
• Without further specifying process / outcomes
  measures as a requirement of reimbursement it
  is clear that HIT will be used to further the
  existing business case ? volume and right
  coding

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The business case for quality and information
management

• Computers are affordable
• Networking is affordable
• Broadband is affordable
• EHR software is affordable
• Interconnecting to all necessary sources of
  information is affordable

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The business case for quality and information
management

• Computers are affordable
• Networking is affordable
• Broadband is affordable
• EHR software is becoming more affordable
• Interconnecting to all necessary sources of
  information will hopefully become affordable
  (perhaps free) and may (if we are lucky)
  improve quality and safety, and not result in
  information overload, cookbook medicine, and/or
  care confusion
• Quality care (information) (knowledge)
  (context)
• Quality care micro-tasking
• Quality care ? time, cost, complexity
• Activities of quality care the above, and
  population and disease management, non-visit
  based care, and care coordination

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Basic EHR
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Decision support for patient
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Integrated registry proactive use by clinicians
and staff
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Advanced EHR Registry eVisits
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Advanced EHR Registry eVisits HIE
PCPs and Specialists
Long-term Care Home Health

• Patient info
• Visit list
• Prob list
• Med list
• Allergy list
• CCR

Labs

• Patient info
• Visit list
• Prob list
• Med list
• Allergy List
• Discharge Sum
• ED Reports
• CCR

Community Hospitals
PBMs

• Reports
• Images
• Med lists
• Formulary

Tertiary Care Hospitals
Imaging Centers

• Diagnosis
• Claims History
• Eligibility
• Referrals
• Authorizations
• Claim Submission
• Claim Status
• Claim Remittance

Payors
Public Health

• Bio-surveillance
• Safety, quality, efficiency indicators

• Personal Health Record

Outcomes Measures
Patients
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The business case for quality and information
management

• Computers are affordable
• Networking is affordable
• Broadband is affordable
• EHR software is becoming more affordable
• Interconnecting to all necessary sources of
  information will hopefully become affordable
  (perhaps free) and may (if we are lucky)
  improve quality and safety, and not result in
  information overload, cookbook medicine, and/or
  care confusion
• Quality care (information) (knowledge)
  (context)
• Quality care micro-tasking
• Quality care ? time, cost, complexity
• Activities of quality care the above, and
  population and disease management, non
  face-to-face care, and care coordination

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Existing P4P initiatives
bad, to
completely meets goals
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Preferred P4P initiatives
bad, to
completely meets goals
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Summary

• There are many risks and barriers to HIT adoption
  that can and should be lowered
• Interoperability only sets the stage meaningful
  clinical interconnectivity will determine its
  value
• Payers must create a sustainable positive
  business case for adoption and optimal use
  (recognizing the implications to the practice)
• HIT adoption per se may add little or no net cost
  to a practice, and may produce little or no net
  value for the patient may require a
  jump-start, but will not require ongoing
  incentives
• Integration of HIT into some practice settings
  can lead to ?
  quality/safety/efficacy/access (? HIT value), and
  doing so will ? provider
  time/cost/complexity (? practice costs)
  requires ongoing structural reimbursement changes
• Incentives should not just be based on numerical
  targets, as healthcare transformation enabled
  thru HIT includes other key elements, such as
  meaningful care coordination / management,
  collaboration with patients, and optimal use of
  non face-to-face care (none of which will occur
  without fundamental reimbursement reform)