News and Old Adages

From the August 2005 Issue

From The Editor

News and Old Adages

By Robin Blair, Editor

If you like to read your good news first, skip down four paragraphs to the one that starts, “The good news is. …” Meanwhile, the bad news is (to paraphrase the lyrics of a popular holiday song): “It’s beginning to look a lot like HIPAA, everywhere you go.”

For anyone who was sentient and working in healthcare in the mid-1990s, HHS Secretary Mike Leavitt’s recent pronouncement of AHIC (the American Health Information Community) and subsequent RFPs aimed at making interoperability a reality in 10 short years hints of the HIPAA extravaganza from which the healthcare sector recently emerged. Perhaps an extreme degree of complexity that generates an extravaganza is an inherent characteristic of regulatory events.

If, like me, you can back up to an even earlier decade, remember the dawn of DRGs and reflect upon how much the grouper mentality has spawned in 20 years, then you too might be thinking that Leavitt’s recent announcement constitutes this decade’s embodiment of government intervention in healthcare. The 1980s were DRGs, the 1990s were HIPAA and the mid-2000s are EHRs, interoperability and AHIC.

Maybe big government needs to intervene in healthcare outcomes. Leavitt says the government pays more than one-third of the nation’s total healthcare costs, and as we used to say when I worked in insurance, “As Medicare goes, so goes the nation.” It’s not unreasonable to expect the No. 1 payer in the nation to want to assume a leadership role in the interoperability mission, if only to ensure that its own future evolves from the proper IT foundation. But I can’t help remembering the old joke, “Where does an 800-pound gorilla sit?” Maybe it fits here.

The good news is that the HHS Secretary is a force to be reckoned with in leading the interoperability charge, no matter who occupies the chair. It helps healthcare to have a heavyweight of that caliber in its corner, and especially one who talks in terms of millions and billions from the public dais. Leavitt has the right timing, the right Presidential connections, the right credibility and the right monetary direction. The fact that he came out of the gate swiftly with a concrete plan and an agenda for public participation sends the right message to all affected audiences: Everyone, get serious about the mission.

But this plan makes me a tad uncomfortable. I’m accustomed to government playing a hefty interventional role in spite of public declarations that an issue is primarily a private-sector issue. In the case of EHRs and interoperability, the government has said, “We’ll play the point position for five years, then hand it back to the private sector.” I can’t remember the last time the government played a point position for any length of time, and then handed back the issue to the private sector, that the private sector didn’t expend a ton of time, money and energy implementing what the government initiated.

Just like chickens and pots, putting an EHR into every provider’s office—and making them talk to each other and to regional oversight organizations nationwide—is an ambitious goal. Valuable, needed, do-able and expensive—yes to each one, of course—but ambitious. Here’s another old adage I hope never applies to the interoperability mission: Cheaper to do it right the first time than to do it over.