March 21, 2013 – On the one hand: miraculous medical outcomes. On the other: wildly dysfunctional delivery system.
Those features of the United States healthcare system create a paradox that sets us apart from any other health system in the world, said health economist J.D. Kleinke, taking the stage last week at “Countdown to Meltdown? Preparing Your Organization for Health Reform & the Brave New Healthcare World,” an event sponsored by the Oregon chapter of the Healthcare Information and Management Systems Society.
As an example, Kleinke talked about a news story earlier this month that perfectly illustrates this paradox. In Mississippi, a baby was born HIV positive, but providers were able to reverse the infection, and the baby is now completely free of the virus. That it happened is a miracle, he said, but the way it happened is a disgrace: the child's mother walked into the emergency room because she was unable to find emergency care elsewhere.
“We live and work in the best of systems and the worst of systems,” Kleinke said.
While the audience was mostly comprised of people who provide information technology to healthcare organizations, Kleinke's talk gave an overview of the current system as well as the changes on the horizon, briefly touching on how those changes would affect IT departments.
He also offered some historical context: “I have a special affection for the role of the employer in healthcare,” he said. During World War II, while dealing with a wage freeze and a labor shortage, shipyards started offering health plans and onsite doctors as a “fringe benefit,” but now employer-backed plans are the norm.
“The employer never should have been involved,” Kleinke said. “They're hobbying in healthcare.”
Now, the healthcare system is involved in a “long, slow death mark to figure out who pays what, when and why,” Kleinke said.
He also talked about the current political climate, and took a jab at Rep. Paul Ryan's (R-Wisc.) budget proposal. While Ryan has claimed he intends to overturn Obamacare, his budget only does away with the individual mandate and the Medicaid expansion – but it creates a Medicare exchange and keeps all the revenue once the Affordable Care Act is fully implemented.
Kleinke said he just finished a yearlong fellowship with the American Enterprise Institute, a Washington, D.C. think tank that brought him on to find all the problems with the Affordable Care Act.
“The biggest problem with Obamacare is Obama's name is now on it,” Kleinke said.
For instance, he said he's seen claims that physicians are “selling out” and joining hospital systems because of Obamacare.
Those claims don't make sense, he said, given that most of the reforms haven’t been implemented, and Obamacare isn’t the reason doctors are joining large health systems. “The reason physicians and hospitals are coming together is because they always should have.”
Kleinke did call the Affordable Care Act “the full employment act for people in HIMSS around the country,” and said information sharing is critical to making sure the reforms are implemented smoothly.
“You can't just basically computerize a disaster, because then you have a computerized disaster,” Kleinke said.
“[Converting to electronic medical records] doesn't happen in three years. It takes 10 years when we're talking about healthcare,” Kleinke said.
During a question and answer session after Kleinke's talk, audience member Lisa Shipley, director of strategic business systems and services and interim chief technology office at Legacy Health, said, “At the risk of sounding like every IT manager, our struggle is always to help healthcare executives understand what we could do with more” and asked for help making a case for increased budgets.
“If you want budgets, you need to make the business case, not the IT case. [Healthcare executives] want to hear how this is monetized.”
In addition to his recent work with the American Enterprise Institute, Kleinke helped create four healthcare information organizations, and is the author of three books: Bleeding Edge: The Business of Health Care in the New Century, Oxymorons: The Myth of a U.S. Health Care System and Catching Babies.
The Oregon Chapter of the Healthcare Information and Management Systems Society is a professional organization dedicated to the development of healthcare information technology professionals throughout Oregon and southwest Washington.
