It’s the HCRA, stupid!
By Shelley Burns
(This is second of three snowclone blogs.)
These snowclones are amazing things. I wasn’t intending to blog about this topic or use another snowclone, but the HMC blog kahuna was kind of insistent.
Politicians and the public are wondering why hospitals and health systems aren’t going gung-ho into the post-reform world. Most are treading water, and administrators are waiting to see what the next big wave will bring. There’s just too much that is unknown and the parts they do know, scares them. They know that their Medicare mix is likely to increase, while the reimbursements from Medicare continue to decline. They don’t know how much, but they are betting it’s going down.
Healthcare administrators know that hospitals need to take the lead in improving the the alignment across providers – clinics, physicians, long-term care facilities, rehab facilities, home health, and assisted-living facilities. But what do the models need to look like? Where will the infrastructure costs be borne? Do you partner or purchase physician practices and ambulatory clinics? What’s reasonable for an ACO? What will HIPPA proponents sue you for as you attempt to share critical information about patient care? How much follow-up is required for the hospital to insure that patients actually follow discharge instructions? What about some accountability from the patients themselves?
Administrators know that hospitals will have to exchange data seamlessly with payers. Hospitals have an uneasy relationship with payers – it’s hard to negotiate with deep-pocket insurance companies that have lots of actuaries to develop mind-numbing carve outs, pre-approvals, and payment requirements. Hospitals are likely to take it on the chin if they can’t align more smoothly with payers, but what happens if the payers don’t want to play nice?
What about the other things on hospitals’ plates? OPPE? RHIE? EMR? CPOE? CD-10? Hospitals have committed significant resources to these systems. How will these acronyms fare in the post-reform world?
It’s the HCRA, stupid. That’s why hospitals are treading water, waiting for the waves to abate before deciding where to set sail. It’s not alphabet soup, it’s alphabet deadlock.
Shelley Burns is head of knowledge management at HMC.
