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Q&A Part 2: Hospitals planning for global payment system

Healthcare facilities must plan for the future of health IT, including meaningful use and ACO payments, in order to be successful.

This is the second part of a Q&A with Shane Pilcher, vice president of Stoltenberg Consulting. In part one, he discussed the upcoming deadline for meaningful use compliance and ICD-10. Here he covers why accountable care organizations are leading to a global payment method and why hospitals always have HIPAA on their minds.

Shane PilcherShane Pilcher

What about, in terms of population health management or utilizing big data? Are any of your clients there yet? Or are they still just trying to get on the meaningful use bus?

Shane Pilcher: The larger facilities that have already gone down this path are more prepared because the more information you have available, the easier it is to identify trends. And identifying trends sooner rather later is critical in providing care and unleashing its impact on the population you serve. That's a significant ROI if you can track that, but the rural hospitals haven't gone far enough down the road to be able to take advantage of that.

Is stage 3 going to be the rocket ship in propelling health IT forward, where all the puzzle pieces will be put together? Or do you think it's going to be more like stage 2, where things are very incremental and move forward slowly but surely?

Pilcher: I was very intrigued by your analogy with the rocket ship. Meaningful use stages 1 and 2 – especially -- I would equate to creating the parts that will be used to build the rocket ship. Stage 3 has a lot of that as well. You've got to get those pieces in place before the full rocket ship can be built and we see it move forward and take off.

Each one of these stages is pieces of parts that have to be put in place to do that. Stage 3, I don't see as the rocket ship being in place and taking off and going to flight, but hopefully it will be some of the finishing touches that will enable us to see that coming in the future.

Anything else to add to ACO-style patient data analytics in terms of utilizing big data?

Meaningful use can be seen as a sprint or a marathon. Those who see it as a sprint are always going to be in a more difficult position because they're just implementing for today, and not really looking at where it's going tomorrow.

Shane Pilcher,
vice president, Stoltenberg Consulting

Pilcher: Absolutely. I think this is the mixed phase. Right now, health IT [is] in a state of flux and will be in a state of flux for many years to come. As we see meaningful use start tapering off, as people hit stage 2 and then stage 3, the ultimate end game for that is business intelligence. So for business intelligence, it all has to start with information, and that information is what we're now getting to a point of beginning to gather. Once you're able to analyze that information, that's when it becomes intelligence. I think that is the next frontier.

Healthcare has always been about 10 years behind business. Businesses have been using business intelligence to define their direction and their processes for a while; hospitals haven't. Some more than others, but the majority of them haven't been able to do that. So not only are we getting into that frontier, but we have to identify the items that we're going to analyze and track and where we're going to apply those efforts to see those them pay off. So at this point that is all starting to be developed and defined. The more data and information there is available, the more you know what you want to assess.

Accountable care organizations (ACOs) are another huge piece of that. Even if a facility or hospital does not choose to put in place a true government ACO relationship, as you see the government go, you'll see the insurance companies go as well. Whether they go ACO or not, global payment is the method of the future. So if you're going to get one lump sum for a certain disease process or diagnostic code, you have to make sure you can provide that care for the amount of money you're getting. It's critical that you're able to marry those operations from the business processes to the delivery of healthcare so you know exactly what it's costing you. And to know areas that you can streamline, save money, improve and increase outcomes, but stay within that global payment structure that's coming down the road. And big data is a big piece of that.

From the ACO and global payment perspective, that's where a lot of hospitals are losing sleep. If you make a mistake there, your bottom line can be devastating. It's highly visible and there's a lot of pressure there to make sure you get it right.

I'm surprised HIPAA didn't show up in your survey results as a big area of improvement, considering all the technology implementations going on and the omnibus rule going into effect this September. Thoughts on why it wasn't?

Pilcher: I think that HIPAA has always been on the forefront of the minds of health IT professionals, especially within a leadership position in healthcare. It's kind of engrained in everything they do on a day-to-day basis. Every step they make going forward, they make sure it qualifies and meets HIPAA requirements. It's not completely new territory, but the new requirements do take it into a bit of a different direction or actually define it in certain areas. The reason it didn't show up in our survey is that it's a worry, but it's not a new worry. Meaningful use and ICD-10 are uncharted territory, but HIPAA is still very much a part of everything they're doing.

From the omnibus perspective, most of it has been to further define [healthcare roles], such as business associates now being just as liable as a [covered] entity is, and different kinds of reporting structures. So I think that will affect HIPAA, and hospitals are keenly aware of how it will affect them.

Any final thoughts?

Pilcher: One thing I like to stress a lot is that the way a healthcare organization or provider uses meaningful use can be seen as a sprint or a marathon. For those who see it as a sprint, they are always going to be in a more difficult position because they're just implementing for today, and not really looking at where it's going tomorrow. So when tomorrow comes, it's even harder to move from where they are to where they need to go. Meaningful use should be seen as a marathon -- it's a long journey.

During your implementation, it's good to implement to the spirit of the regulation, not necessarily the law. You have to meet the regulation itself, but if you only go as far as to what those regulations are asking for-- as they amend it in the following stages-- it gets even harder to get there. But if you see it as meeting the intent of it -- understanding where it's going and why -- you can take it further and be better prepared for other initiatives down the road.

Shane Pilcher is vice president of Stoltenberg Consulting, which provides support for senior healthcare leaders. Let us know what you think about the story; email or contact @SearchHealthIT on Twitter.

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