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Monday, May 5, 2014

Meaningful Use: who's making bank here?

The feds just released a huge dataset comprised of Meaningful Use attestations by EHR vendor to date. The dictionary:

552,406 data rows in the main sheet. You can grind these sixteen ways to Sunday for useful substrata. Here's my quick Excel tally of the aggregate ranks to date, all years, all programs (EPs, EHs, Medicare, Medicaid), top 25:

An "EPIC situation," no? While their relative share has decreased as the program has matured, they still rule, far and away.

Note that the top 10 comprise ~2/3rds of the attestation action and the top 25 nearly 80%. Interesting that the freebie Practice Fusion is ranked 9th (beating out even Jonathan Bush's anti-REC athenahealth).

I wonder how much of the $22.9 billion MU money paid out to date [1] passed through to the vendors, and [2] cycled back around in taxes? To the latter question, were it, say, ~20%, you'd have a bit more than $5 billion coming back to the Treasury.

I'd also like to know how much the Meaningful Use program has cost the taxpayers in total, net (incentive payments, RECs, administrative costs at ONC and CMS, etc).


Just out (pdf).

In August of 2013, the Office of the National Coordinator for Health Information Technology (ONC) announced the opportunity for a no-cost extension of the remaining funds available through the American Recovery and Reinvestment Act of 2009 (ARRA).
In order to assess how Regional Extension Centers (RECs) are going to prepare for a future in which funding was uncertain, HIMSS developed a study to evaluate organizations’ preparedness to sustain operations in the future. This survey assesses a number of factors including key information technology (IT) priorities, the business issues impacting RECs, and the types of strategic relationships organizations are creating to sustain viability...

By all accounts, the REC program has been extremely successful to date. Over 147,000 providers are currently enrolled with a REC. Of these, more than 124,000 are now live on an EHR and more than 70,000 have demonstrated Meaningful Use. Additionally, 872 Critical Access Hospitals (CRHs)/SRHs have been paid for MU1. Yet, as the ARRA funding winds down, there are questions around the financial sustainability of these organizations.

Findings from the 2014 HIMSS Regional Extension Center Study suggest executives are optimistic about the future of RECs. For example, 85 percent of executives responding to the survey indicated they did not expect to close their doors, despite the fact that 28 percent of the 36 executives responding to the 2014 HIMSS Regional Extension Center Study indicated that their funding ran out prior to the end of February 2014.

Indeed, RECs are moving forward with a number of strategies in which to ensure they can continue to fulfill their mission. Approximately three-quarters (72 percent) had applied for a no-cost extension of their ONC funding. Nearly half are creating strategic partnerships with other organizations in their service area. Finally, approximately half reported that they have received state funding to maintain operations...

...[A] handful of the RECs responding to this study noted that they have already been generating revenue streams to sustain operations going forward. One respondent noted that they are earning money from “provider membership fees, consulting services, selling IT resources and IP to other RECs and government entities”. This is not an easy model to achieve, and not all respondents believed that this model will yield full-blown sustainability. One respondent suggested that “the level of interest remains high among providers to continue with Stage 2 and embark in PCMH (patient centered medical home) recognition; the revenue generation from such activities is insufficient to maintain full-blown REC services”. Another noted that many organizations, including “RECs are not accustomed to looking for sustainability models nor have the infrastructure to operate as a for-profit entity. This has been the biggest concern with being a REC”. Finally, a respondent commented that “their organization will not commit to building a sustainable model”.
I continue to bemoan the short-sightedness of HHS not infusing the RECs with funding sufficient to get them and their clients through Stage 2.


From the Thedacare Center for Healthcare Value.
If the history of revolution around the globe has taught us one thing, it is this: leadership succeeds only when it learns to evolve. No matter how necessary and just the rebellion, when the dust clears, the leaders need to govern, to make systems work in order to keep a country or an organization running. And that requires an ongoing willingness to change and adapt.

For nearly a decade, the lean revolution in healthcare centered on improving quality and reducing costs in advance of the huge systemic changes we all knew were coming.With healthcare bills bankrupting families and threatening to do the same to the United States, major hospitals and health-system leaders began experimenting with various improvement methods. A healthy percentage of those organizations embraced lean thinking and adopted tools and methods from the Toyota Production System...

It turns out that revolutionary change is necessary, but it is not sufficient.

The kinds of change that come from rapid process improvements are essential but are only the first steps of a lean journey.The core work of the transformation is changing the culture—changing how we respond to problems, how we think about patients, how we interact with each other. This is an issue not only in healthcare organizations; we have also seen manufacturing, service companies, retailers, and government agencies all struggle with the same issues.When lean thinking goes only skin deep and management does not change, improvements cannot be sustained, and savings never quite hit the bottom line.
We are finally moving beyond the age of heroes chasing exceptions and are looking forward to innovations in management that will move us even further ahead.The faster we can implement these ideas, the better it will be for all of us—patients, physicians, nurses, managers, and everyone who pays for healthcare.
—John Toussaint, MD Founder and CEO,ThedaCare Center for Healthcare Value, January 2014
Not available in eBook format. Yet.


I recently finished Nomi Prins excellent, best-selling history of the modern U.S. financial system, "All the Presidents' Bankers."

Read my Amazon review here. Highly recommended. I have some personal history with the often slimy FIRE Sector (Finance, Insurance, and Real Estate).

Playing off the phrase "making bank," I've been bugging Ms. Prins and her agent with this idea.

My quickie Photoshop. A no-brainer, this one. She is utterly gracious to put up with (and respond to) my emails.

I can't help it; I just have ideas all the time. I mostly just give them away, e.g., see this one. And this old one.


More to come...

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