The View from Here

By Pete Butler

A friend of mine once had two cats that fought so violently, each had to be kept on separate floors. One day, after a particularly bloody fight (someone left the gate open), my friend’s vet suggested a radical solution. “Put the cats in a corner with a vacuum cleaner and turn it on.”  They did. The cats were scared to death. My friend felt bad. But when they turned the vacuum off, the cats huddled together in the corner. And they never fought again! The vacuum acted as a common enemy. It brought them together.

It’s feeling a little like being stuck in a corner with a vacuum cleaner right now in healthcare. The “vacuum” would be the money being sucked out of doctors’ paychecks, hospital’s revenue, employer’s health benefit budgets, insurance companies’ margins and patients’ pockets.

Medicare’s 21% cut to doctors’ payments is looming. ARRA incentive money is not enough to pay for meaningful use. Recovery Audit Contractors (RACs) are taking back money already paid. Security breach penalties are in the news every day. States are rejecting huge insurance rate hikes, yet high unemployment rates are throwing a wrench in the risk pool.  

There is some hissing in the corner.  However, there is also some huddling.

Huddling indicators: increased focus on accountable care organizations, Health Information Exchanges, extending EHRs to community physicians, PQRI reporting. All depend on the successful coordination of quality care, upon which the federal incentives are based.  Formerly separate, competitive healthcare entities – community physicians, hospitals, clinics, patients and even payors – are now working together to find ways to not simply reduce costs and get incentive monies, but often to survive.

What will be needed for this new paradigm? Technology is a given. How else will you proactively determine if you are reaching the 80 percent reporting rate for PQRI measures?  If the compliance department can’t audit enough providers, exposure to risk increases along with likely fines.

However, technology needs people, processes, and communication among all stakeholders to be able to produce results that pay, literally.

Therefore, if I were to invest in one area, it would be process improvement and operational efficiency. Two overused terms that are rarely executed.

Pete Butler