Electronic Health Records - Two Not-So-Minor Concerns

No question, as EHRs are implemented in hospitals, elements of care will improve. Cordinated processes and integrated information, clinical protocols and patient portals will all benefit the provision of healthcare. BUT, two issues loom large. First, the cost of these systems is significant and reimbursement of a portion of the cost of implementation will hinge on "meaningful use" being achieved within a timetable proscribed by the Federal government. That timetable is, to say the least, aggresive. Our healthcare associations and various organizations are working to have these deadlines extended.

Second, in any complex system change there can be unintended consequences. Anne Zieger, in her blog, The nextHospital Manifesto, posted "Do EHRs Kill People? Maybe So". The content follows:

Here’s some cautionary words on the adoption of electronic health records, in an essay from the rich archives of wonderfully snarky and insightful site thehealthcareblog.com.
Since IANAT (I Am Not A Techie), I can only offer an analyst’s take on the matter, but I believe author Margalit Gur-Arie’s argument makes great sense. Anytime a technology goes beyond being a tool to driving decisions, humans have to adapt — and that breaks their stride. And off-balance care can lead to patient deaths. As she notes:

If EHRs become as pervasive in everyday medicine as ONC is proposing, every patient will eventually be touched by an EHR. It is very likely that some errors will be prevented by the sheer existence of an EHR but new and unfamiliar errors will also be introduced as side effects.

I continue to hope we can find a way to make EMR use simple, natural and fluid, but honestly, I’m still pretty skeptical it will happen. So thanks to Gur-Arie for reminding people that EMRs, EHRs, PHRs and all other related tools are far from a panacea.
 
Anne, I tend to agree. As we develop this crucial new healthcare delivery tool , caution had better be the watchword.

Hospital Mergers and Consolidations

With the pressures of the economy, reimbursement trends and the spectre of total transformation that will be required by healthcare reform, consolidation in the health care industry is taking place at a record pace. It’s difficult for small to mid-sized hospitals to compete against larger health systems in many markets, and the depressed economic climate has led some hospitals to seek out opportunities for mergers.

Larger systems are strategically evaluating the markets they want to be in and exiting from less attracive markets. In addition, smaller hospitals and systems are understanding their survival may hinge on merging with or being acquired by another system.

Boards of Trustees and community advocates want to maintain their independence, and senior managers may be concerned with their vulnerability in a merger. Nevertheless, I believe this trend will continue, and even accelerate. Think of the difficulties a smaller stand-alone hospital, or even a small system, will encounter as they deal with the system, process and resource demands in adjusting to the new realities of healthcare delivery.

The changes afoot are dramatic: Implementation of meaningful use of electronic health records; developing Accountable Care Organizations; re-focusing on, measuring and reporting on quality indicators (linked to reimbursement); and strengthening physician integration are just a few of the challenges to be met. Not least is the need to totally transform the way in which healthcare is delivered, so as to survive what I believe will be an environment where reimbursement from all payors will be driven down towards Medicare levels.

Then there are the economies of scale that have always been available to larger systems. To name a few: departmental consolidations and centralized functions; access to experts who would otherwise be too costly; and negotiating leverage with insurors and suppliers.

This is not all bad news. The takeaways are:

• These are exciting times for hospitals and healthcare systems
• Change is good, and the nation's healthcare system will benefit in the long run
• Surviving systems will have the talent and resources to deliver high quality care in an affordable way.
• As leaders, we need to put aside parochial concerns, and strongly consider seeking out partners that will ensure our organizations will continue to exist, grow stronger and deliver cost-effective, quality care.

This is, of course, just my opinion, and I welcome meaningful feedback and debate.

Cash is King

I am, as they say, "in transition". That means I'm networking, developing my "personal brand", combing job postings and going on job interviews. I state this not to generate empathy because I'm sure the right opportunity will come along. I mention it as a backdrop for this post. Cash is king. I have been on several job interviews, and regardless of the organization, it's size, it's revenue stream, it's mission, when I ask - "What keeps you up at night?", the answer is invariably cash flow issues.

These days, in healthcare and other non-profit organizations, earnings are less important than cash. The cash flow statement is what external lenders, investors and potential donees focus on. Perhaps, if you're creative and aggressive, revenues are rising. But if third party payments are slowing down, or you're not on top of contractual payors and grantors, or you're not maximizing the potential billing you can squeeze out of every contract, cash flow is not keeping up with revenue.

It's critical to measure and monitor cash, so it's essential to develop cash flow projections, preferably of the rolling, thirteen week variety. Refresh the projections weekly. Look for points in time when your liquidity could be in jeapordy, and plan for how you might deal with the situation.

Of course, your cash situation won't improve on it's own, so now is the time to seek opportunities to streamline operations, create new revenue streams and strategically plan for better times. Good luck, and if you need someone to bounce ideas off of on where to start, feel free to contact me.