Stark Implications
This week brings a guest blog post from Joel Andersen, VP at client Purkinje, on the dark side of Stark law reform. The piece originally appeared in Advance magazine.
The Stark Truth
While the Stark Law reforms have been hailed as a positive development for health care, a closer look at who is singing its praises may show an ulterior motive. Small and medium sized physician practices, which deliver 70 percent of the health care in America, could be force-fit with software from large acute care software vendors, many of which are ill-equipped to understand and service the needs of today's busy medical practices.
Ambulatory care is a very different world than acute care. In Stark law "reform," EMRs could likely become a loss leader for acute care technology vendors and hospitals. Many acute care vendors will practically give away their ambulatory solutions in order to secure millions of dollars in acute care software business from hospitals. As often discussed in the media and rankings from industry research groups, their ambulatory-specific technology is often dated, cumbersome to implement and use, difficult (or impossible) to integrate, and serviced by vendors who "just don't get it."
Hospitals are often complicit in their own way. Hospitals, like any business, are looking for ways to grow business and want to drive admissions and use of ancillary services. The potential lure of free or low-cost EMRs that are integrated with hospital systems and data generated within their facility such as transcription, lab, radiology, and ADT may do just that. However, EMRs in this arrangement will likely become glorified order-and-result systems tied directly to the hospital.
The hospital will more than likely host the system and have access to the patient data generated by the physician. Many physicians are uncomfortable with such an arrangement. Acute care vendors, traditionally reluctant to develop interoperability with third parties, become even more so with Stark law reform. And hospitals won't demand it, since they'll want medical groups to use the hospital's ambulatory solution.
Cost, ease of use and return on investment are the top concerns of small- and medium-sized practices. Many companies dedicated to the ambulatory market have made great strides addressing these concerns with low-cost Web-based technology years ahead of the acute vendors. Certain large acute care vendors and hospital interests could stifle free market choice of EMR solutions more appropriate for the ambulatory market.
No one would disagree with the benefit of physicians getting financial assistance to acquire EHR technology. But acquiring technology and successfully utilizing technology are two different things. Our goal as a health care system in the area of EHRs is not to see a computer in each exam room loaded with software that goes widely unused. While physicians must take responsibility for adopting the technology, vendors are equally responsible for creating intuitive yet powerful software, as well as providing training and guidance to position each practice for success. Vendors focused specifically on the ambulatory space are doing just that. More important, they are eliminating the cost and implementation barriers associated with EHRs previously encountered by physician practices while enabling practices to maintain autonomy.
Utlimately with Stark Law reform the government is passing the buck by not wanting to take financial responsibility for driving EMR adoption. The government is pushing the responsibility to hospitals to subsidize the cost of the technology -- creating the very issue the original law was intended to prevent.
Government should spend more time protecting physician incomes related to Medicare reimbursement or providing more meaningful funds for pay-for-performance programs as opposed to creating an environment where physicians become servants of their local hospital. The government should realize that many EMR vendors dedicated to the ambulatory marketplace have taken on the challenge of producing quality products at a low cost and are already delivering results.
Posted by Shawn Whalen on May 8, 2007 at 12:51 PM
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