Health care organizations which do not qualify for incentive reimbursement have in large part not implemented EHRs, leading researchers involved in a study published in the March issue of Health Affairs to conclude that it is the incentives rather than factors such as improving patient care which are driving EHR adoption.

Under the 2009 federal stimulus legislation, health care providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments. The incentive program, however, excludes home health agencies, inpatient psychiatric hospitals, inpatient rehabilitation hospitals, long term acute care hospitals and nursing homes. While EHR adoption in eligible, short term acute care hospitals is currently at about 12%, ineligible health care organization EHR adoption was described in the study as “abysmally low.”

The study included:

• 4,629 general short term acute care hospitals
• 486 psychiatric hospitals
• 401 long term acute care hospitals
• 237 rehabilitation hospitals

Only 6% of long term acute care, 4% of rehabilitation and 2% of psychiatric hospitals had implemented EHRs. The likely factors impeding implementation were cited as the ongoing vendor focus on the acute care environment (which benefits from incentive reimbursement) and uncertainty regarding which EHR would best suit their unique environment.

With such large numbers of health care organizations continuing to operate in a paper world with little incentive to change, the goal of achieving either the quality or efficiency of care EHR technology promises will remain elusive. Creative and workable solutions will need to be devised to ensure that these disenfranchised health care organizations, which play such a critical role in the health care delivery system, are sufficiently incentivized to adopt EHRs.

In 2010, a study was conducted by Georgetown University and Booz Allen Hamilton to define trends, challenges and lessons learned surrounding the implementation of ICD-10 and to provide actionable information to serve as a resource for organizations navigating the transition. The participating health care organizations were large hospitals, integrated health care systems and other national leaders who were likely to have initiated the process far in advance of the October 2013 deadline. Interviews were conducted with employees of seven health care organizations in March and April 0f 2010. Among the trends and challenges identified by these organizations identified were:

• Each organization had appointed project managers and steering committees to monitor the transition
• Five organizations were in the early stages of impact assessments
• Five of the organizations had yet to budget significant funds
• The organizations reported difficulty creating a sense of urgency among staff concurrently dealing with the transition while managing other recently implemented regulations
• Four organizations reported difficulty in raising awareness among physicians
• One organization reported difficulty locating timely and accurate information about the transition
• Three organizations reported difficulty staffing the transition

Fast forward to a KLAS survey of 163 health care providers conducted in October 2011. Progress in the intervening time has apparently not been significant particularly in some of the same areas identified in the 2010 survey. The KLAS survey found that less than ten percent of healthcare organizations are over halfway to being fully prepared for ICD-10. A lack of understanding regarding how extensive transition to ICD-10 is persists. And while most know the transition will be costly, the survey also found that many providers had yet to establish an ICD-10 budget.

Across the organizations surveyed, more than half of the respondent (54%) indicated that training was their number one concern and physician and nurse readiness also ranked high at 44%. Nearly two thirds (65%) of organizations also expect to use 3^rd party firms to help them prepare. The longer they wait the more difficult and costly it will likely be to find qualified resources.

Possibly in response to this widespread lack of preparedness, as well as pushback by the American Medical Association, Marilyn Tavenner, Acting administrator of the Centers for Medicare and Medicaid Services (CMS) announced at an American Medical Association conference held in Washington, DC on February 14, 2012 that CMS now intends to re- examine the timeline for the switchover to the new code-set. A key factor may be current problems implementing the 5010 transaction set which is a prerequisite for ICD-10. The Medical Group Management Association (MGMA) also recently asked CMS to postpone enforcement of the 5010 set to June 30 because a large number of physicians are encountering payment delays due to the transition.

Regardless of deadline, for some organizations no amount of time will ever be sufficient. As the deadline draws closer the pushback is likely to continue and potentially increase in intensity. Should CMS implement a delay? If so, how long is long enough?

As we talk to many attendees at the HIMSS 2012 show about their strategies for meeting the ICD-10 October 2013 deadline, the American Medical Association continues its efforts to delay or stop the implementation altogether.

A letter which was recently sent by AMA Executive Vice President and CEO James Madara to House Speaker John Boehner outlined the view of the AMA that the timing of implementation “could not be worse.” It goes on to cite that many physicians are currently implementing electronic health records in their practices and that physicians are also facing present and future financial penalties if they do not successfully participate in multiple Medicare programs underway today. These include the e-prescribing, Meaningful Use and Physician Quality Reporting programs. According to Madara, ICD-10 implementation will increase billing codes by six fold and could cost a single practice anywhere from $83,290 to $2.7 million.

Although the arguments outlined in this letter have been made before the timing suggests a new strategy. If the GOP attains the White House in this election year, Republicans will seek to overturn Health Care Reform. The ICD-10 implementation date is currently October 2013 which is after the new President will take office. If that new President is a Republican the AMA could and will likely argue that the new administration lifts this requirement for physicians who care for Medicare patients.

However, major investments by physicians and hospitals in ICD-9 to ICD-10 conversions are currently well underway. Additionally, the broad view remains that the ICD-9 code set is outdated and the benefits of ICD-10 clearly outweigh the costs. The AMA may be making a last attempt to avoid the inevitable.

Despite significant investments in healthcare IT, recent studies have found a “surprising” level of skepticism about its benefits. Many physicians are still not convinced that electronic health records or health information exchanges will improve patient outcomes, access to services or reduce unnecessary procedures. As these are the very benefits cited for driving adoption of both EHRs and HIEs, why does the disconnect between the promise of healthcare IT and actual acceptance still persist?

There are significant gaps identified between US physicians and their counterparts. US doctors are on the low end of worldwide physicians who think healthcare IT use will improve diagnostic decisions, compared to their international colleagues.

Younger physicians are also more likely to believe that healthcare IT has a positive impact across a wider range of benefits, and believe EHRs and HIEs will improve care coordination and most believe these technologies will improve access to quality data to support clinical research. A lower percentage of older physicians are in agreement.

What might account for this difference?

Typically, younger physicians have just had the experience with and tend to be more open to using new technology. An older physician who may never have used technology in patient interactions is likely to be at least initially uncomfortable typing while talking to a patient. Increased familiarity makes a real difference in perception of benefits. Those physicians who use technology routinely for a wide range of health care IT functions such as electronic entry of patient notes, electronic ordering and prescribing have a more positive attitude toward the overall benefits technology can deliver.

Physicians do want to embrace change but for a significant, and in many cases, older population, raising their comfort level with technology remains a challenge. The healthcare organizations that maintain this awareness actively involve physicians in developing manageable approaches, achievable targets and shorter term outcomes can increase the familiarity of physicians with both technology as well as their perception of its benefits.

Forecasting industry trends is a common theme at the beginning of a new year. PwC’s Health Research Institute recently polled 1,000 adult consumers and highlighted interesting findings for 2012.

Some of the key trends noted in this survey were:

• 52% of consumers surveyed said they would be interested in an insurance plan that covered effective treatments at little cost to them but charged higher prices for new treatments with unproven benefit.
• Nearly 75% of the respondents indicated a preference for healthcare organizations that encompass a wide range of health related activities and services. Consumers see integration as a boon to quality and cost.
• 60% said they would be comfortable having their health data shared among healthcare organizations if doing so would improve coordination of their care. However, clear privacy and security policies were noted as a differentiator being the top reason cited by consumers (30%) as the reason they would choose one hospital over another (with cost, quality and access equal).
• Consumers agree that healthcare is a prime election issue: It ranked equally (52% of respondents ranked healthcare either first, second, or third) with the national deficit as the second most pressing election issue after job creation.
• Nearly half (46%) of consumers say they have deferred care at least once this past year because of how much that care cost.
• 61% of consumers agree that pharmaceutical and biomedical research is an important engine for economic growth in the US. And 75% of consumers think that clinical trials should be conducted in the United States even though that might mean longer approval time and higher priced drugs.
• One-third of consumers (34%) reported they would have a less favorable impression of a health insurance company that decided not to participate in its state’s health insurance exchange.
• Nearly a third (32%) of consumers has used some form of social media (Facebook, YouTube, blogs, etc.) for healthcare purposes.

As this election year progresses, these and other emerging trends, opportunities and challenges facing the health care industry are certain to keep a sharp focus in this area.

What thoughts do you have on the above statistics? Do you agree with many of the opinions?