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All Things HIT

May 17 2012   1:30PM GMT

An “Epic” scenario to a real BIG problem!

Posted by: AllinHIT
EHR, EpicCare, Obesity

The Scenario: Prior to walking into the exam room, the physician reviewed the patient’s vitals, BMI, and social history, marking them as “reviewed” in the Epic system to meet the new payor requirements. After reviewing the patient’s clinical information, especially the BMI, he knew this patient qualified for the new Obesity Management program, an initiative that will allow for him to increase his level of service whereby if certain patient goals are met, co-pays could be reduced. In this case, the physician views the program as a win-win for both doctor and patient. Since this is a Medicare patient, the physician gets a higher Medicare SGR and the patient reduces his co-pay, simply by getting healthier!

The physician walks into the room to deliver the news: “I must enroll you in Medicare’s Weight Goal program.” The physician then logs into Epic Hyperspace (their portal), accesses the Visit Navigator and opens the patient chart. He inputs “obesity” into the problem list and “associates” the goal of losing 20 pounds with the obesity problem. The patient learns that if the goal is met, he has an opportunity to earn “goal points”, which he can put toward co-pays. However, if weight is gained, he could face a reduction of benefits. The physician will use the Epic system to record the progress, and if the patient complies with the care plan and meets the goal, it’s a win-win for both patient and physician.

While the scenario is fictional, the steps described in recording the “problem” and associating a “goal” in an Epic system is very real. This “Epic” feature will possibly get more use after reading excerpts from recent reports on obesity authored by the Institute of Medicine (IOM) and the CDC.

The IOM report is extensive, with over 450 pages, and argues the U.S. needs multiple strategies to fight obesity, including a possible “soda” tax. The soda tax will be applied to all those fitting the scenario as described above. Considering the IOM is a division of the National Academies, an organization consulting the U.S. government on health issues, this scenario (or something similar), is not unrealistic. As many of us industry folks know, as Medicare goes, so do commercial payors (ex: PQRI started P4P). The CDC report reveals the staggering cost increases we will face if the obesity problem is not addressed, noting that care for obese Americans in the next 18 years is projected to reach $549.5 billion!

I don’t know if this “Epic” scenario is part of the answer. However, it’s obvious that something must be done. We, as a society, can not continue to support a preventable disease/condition while it bankrupts our healthcare system. It will take a team effort from payors, employers, EHR vendors, and of course, personal responsibility. I give Kudos to Epic and other EHRs for having the capabilities!  However, it’s the user — the patients’ application of these features — which makes it an “Epic” solution to a really BIG problem.

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