The Department of Health and Human Services (DHHS) announced on Monday, January 26, 2015, that it plans to pay providers of the Medicare program based on value and quality, increasingly over the next three years. Sylvia Burwell, the U.S. Secretary of Health and Human Services, noted in a Perspective for the New England Journal of Medicine that same day: “this is the first time in the history of the program that explicit goals for alternative payment models and value-based payments have been set for Medicare.”
Having predicted this day for a long time now and spending most of the last five years at Oregon Health & Science University School of Medicine taking Biomedical Informatics-related courses, doing research and writing, I am most pleased this day has finally arrived.
Ms. Burwell noted “Alternative payment models include accountable care organizations (ACO’s) and bundled-payment arrangements under which health care providers are accountable for the quality and cost of the care they deliver to patients.” The DHHS also is “engaging state Medicaid programs and private payers in efforts to make further progress toward value-based payment throughout the health care system.” Thus, the shift in the market from fee-for-service procedures to payment for quality and cost-effectiveness is continuing, but will do so at even a faster pace.
What does this mean? The Centers for Medicare & Medicaid Services (CMS) issued a facts sheet on the same day of the DHHS announcement and Ms. Burwell’s Perspective. It is entitled “Better Care. Smarter Spending. Healthier People: Why It Matters.” CMS is focusing on three key areas: (1) improving the way providers are paid (by aligning incentives), improving and innovating in care delivery (finding new ways to coordinate and integrate care), and by sharing information more broadly to providers, consumers, and others to support better discussions while maintaining privacy (through electronic health information to improve care and to bring the most recent scientific evidence to the point of care to bolster clinical decision making.)
Health Information Technology (HIT) and Biomedical Informatics are the key to this program’s success and to the transformation of the current fee-for-service system to payment for quality and cost-effectiveness. HIT provides clinicians with more of an opportunity to focus on patient-centered care. It facilitates the alignment of incentive and holds the promise of greater cost savings, while maintaining or enhancing quality.
Although many systems have electronic health records linked to clinical discussion support and
computerized physician order entry and e-prescribing, much of the technology is seen as non-user friendly, and adversely affecting work flow. It is not universally interoperable and not easily adoptable.
South Florida is a leader in the development of HIT and biotechnology. With my recent move to the Fort Lauderdale office of the leading law firm of Broad and Cassel, I look forward to working with others in the industry in this transformation, as I am completing my on-campus requirements at the Oregon Health & Science University School of Medicine as a PhD candidate and a National Library of Medicine post-doctoral fellow. A key will be building electronic health platforms that clinicians and health systems truly embrace.
Unfortunately, we are not there yet. As the February 2, 2015 edition of USA Today reports: “A group of 37 medical societies led by the American Medical Association sent a letter to Health and Human Services last month saying … that today’s electronic records systems are cumbersome, decrease efficiency and, most importantly, can present safety problems for patients.”
Paul R. DeMuro, Of Counsel, Broad and Cassel, Fort Lauderdale, Florida.
