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Electronic Health Records – The Bane of Medical Progress?

For years, indeed decades, Americans have reluctantly confronted the traditional ritual of having to manually complete paperwork before seeing a healthcare provider. Recollection of dates, medical conditions, and other important and critical medical details are challenging to put on paper prior to meeting with a new provider unfamiliar with our past medical history. Additionally, obtaining access to personal health records from one health provider to another has been a test of endurance for patients and caregivers alike.

With these and countless other challenges of providing accurate, up-to-date, and complete information about patients at the point of care, it is no wonder that a push to overlay medical records with sophisticated technology was long overdue. Electronic health record (EHR) goals are widely accepted to be the rocket fuel that helps ignite a very complex and grossly underperforming U.S. healthcare system:

  • Enable quick access to patient records for more coordinated, efficient care
  • Securely share electronic information with patients and other clinicians
  • Help providers to more effectively diagnose patients, reduce medical errors, and provider safer care
  • Improve patient and provider communication and enable health care ‘convenience’
  • Enable safer, more reliable prescribing
  • Promote legible, complete documentation and accurate coding and billing
  • Enhance privacy and security of patient data
  • Help providers improve productivity and work-life balance
  • Enable provider to improve efficiency and meet their business goals
  • Reduce costs by having decreased paperwork, improved safety, reduced duplication of testing and improved health

Yet, this belief that EHRs will enhance efficiency and promote safe and effective care may not be hitting its intended bull’s-eye – at least for the present time. A recent joint article, “Death By 1,000 Clicks: Where Electronic Health Records Went Wrong,” researched and written by Kaiser Health News and Fortune Magazine reveals that EHRs have grossly underperformed on many key fronts.  In fact, EHRs are proving to have more unintentional consequences that cause patient harm and accentuate job burnout for many providers using them.

Applying shovel-ready financial stimulus money to jump start the economy during the Great Recession, which began in 2007, the federal government, thanks to legislators passing the HITECH Act in February of 2009, infused a huge chunk of change ($36+ billion) to incentivize hospitals and physicians to embrace health information technology into their practices.

How many other industries are given ‘free’ government money to motivate the use of information technology? Off the top of my head, very few – if any. Usually, due to market forces dictating improved efficiencies, most business sectors allocate their own financial resources to reinvest in information technologies. I realize there are tax incentives for doing this, but having manna fall from the sky – much like HITECH – is truly a gift that should have paid great dividends to all – including U.S. taxpayers.

In fairness to healthcare providers and software vendors, the HITECH approach was much too optimistic and ambitious to succeed during a relative short period of time. As this story indicates, there were too many cooks in the kitchen, in addition to the crazy requirements that software vendors required of their healthcare clients, including gag-clauses on flawed software.

Since implementation of the HITECH Act, there have been thousands of reports of deaths, injuries and near misses linked to the shortcomings of digital systems. Equally frustrating is that many patients continue to report difficulties on receiving copies of their complete electronic files. Take heart, however, proposed federal rules by the Department of Health and Human Service should, according to Sen. Lamar Alexander (R-Tenn.), “make it easier for patients to more quickly access, use and understand their personal medical information.”

Because the U.S. has many different software manufacturers in the healthcare space, each attempting to maintain their own ‘proprietary’ domain for exclusivity purposes, the EHRs are similar to the existence of diverse human languages that occurred in Genesis 11 when many different languages were spoken during the construction of the Tower of Babel.

With new scrutiny of the current EHRs, it is time to re-calibrate the existing cocktail of EHR-systems and determine what makes the most sense to patients, providers – and taxpayers. Singing from the same sheet of music would be a great start.

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20th Iowa Employer Benefits Survey Now Underway!

At Haystack Rock in Cannon Beach, Oregon (2002).

This year marks the 20th year that we have been performing the Iowa Employer Benefits Study©. When this study began in 1999, I had two toddler daughters, one of which is now two years post-college and working in the Twin Cities, while the other is about to graduate from St. Olaf College. Between my daughters and this survey, it’s easy to measure just how fast the years have flown by!

With the 2019 survey, as in the past, we plan to randomly survey at least 1,000 Iowa employers from a variety of sizes and industries. We have found this number of respondents to be extremely beneficial when comparing various industries and size categories to one another.

However, contrary to the past, this year’s survey is being conducted three months earlier in the year, allowing the study to become available in July. By doing so, many employers will have access to these results while strategizing potential changes to their benefit plans during the fall renewal season. Because of this, we are excited about performing this survey process earlier.

If you happen to be an employer who is randomly-selected to participate in this year’s survey, we would greatly appreciate you taking the time to share your confidential data with us. By doing so, you will receive, via email, the Iowa Employer Benefits Study© report that summarizes key findings. Please know that your information will only be used on an aggregate basis and combined with data from other participating employers. Most importantly, we will protect your anonymity and the confidentiality of your responses to the fullest extent.

Twenty years is a milestone for us. As mentioned, much has changed over these two decades, but during this time, I have always been very grateful to all Iowa employers who have taken the time to share their information with us. We take our work seriously and will always value your trust in our survey.

To stay abreast of employee benefits and healthcare issues, we invite you to subscribe to our blog.

A Potential Game Changer – Making ‘Secretly-Negotiated’ Medical Prices Public

Have you ever had a clogged bathtub drain or toilet? Yep, me too. For the waste to exit efficiently, it takes deliberate effort to remove the obstruction that hinders the plumbing system.

The U.S. healthcare system is somewhat akin to an inefficient plumbing system. As is said, “Every system is perfectly designed for exactly the results it gets.” So, in healthcare, when it comes to having transparent prices (and outcomes), our system was DESIGNED to have clogged ‘plumbing.’ Allow me to explain…

The current healthcare pricing system is broken and indefensible. It is a known fact that the escalating prices we pay for our healthcare services is a black box. Whether it be for hospitals, doctors, pharmacy or other healthcare providers, we have no idea what the negotiated prices actually are between insurers and health providers, at least until sometime AFTER the services have been rendered. But this black box was carefully designed to work as intended. To paraphrase noted economist Uwe Reinhardt, where there’s mysteries (in pricing), there’s (larger than normal) margin to be had. In healthcare, obscene money is made when it is allowed to operate in a dark room of denial and obfuscation.

It’s one thing for hospitals to now publicly disclose their ‘list’ prices – (effective January 2019) – but it’s another to disclose the ‘real’ prices that have been negotiated and paid by the insurers we choose to use.

Negotiated prices are largely bound by confidentiality agreements between healthcare providers and insurance companies, and are so closely guarded that even mega employers are not allowed to penetrate this veil of secrecy. While in Indianapolis this past week, I had lunch with the manager of General Motors’ benefits plans who shared her frustrations about these backdoor deals around the country. If this secrecy happens to General Motors, it happens to all employers.

New Transparency Approach Provides Hope

But there is hope. A Wall Street Journal (WSJ) story broke this past Friday that may possibly open up the drain and allow the plumbing to finally function properly. The Trump Administration, through the U.S. Department of Health and Human Services (HHS), is seeking to require hospitals, doctors and other healthcare providers to publicly disclose these secretly negotiated prices – which are the relevant prices we all want to know.

HHS is requesting public comment on whether patients have the right to view the discounted prices in advance of obtaining care. The invitation for comment was actually outlined in a little-noticed passage of a broader patient-data proposal released in March, tucked away in a 700-page draft regulation. According to the WSJ article, the Administration could issue a final rule mandating the disclosure of negotiated rates after the comment period closes on May 3.

Watch for Opposition to Fight this Move

It is often interesting to observe both insurers and healthcare providers who have historically acknowledged the importance of having ‘transparency’ in healthcare. These same organizations, however, appear to believe that ‘transparency’ can only happen when it suits them.

One prime example is the American Hospital Association (AHA), which opposes the move to make negotiated prices public. As reported in the WSJ article, an AHA executive vice president commented, “Disclosing negotiated rates between insurers and hospitals could undermine the choices available in the private market…While we support transparency, this approach misses the mark.”

Misses what mark? What type of transparency is the AHA looking for? This is a baffling comment made by a trade organization whose sole purpose is to serve hospitals, but at the public’s expense. We don’t need to have the AHA tell us what ‘transparency’ should be…they, along with insurance companies, have had their chance to fix this clogged drain for decades, but they have habitually – and deliberately – failed. Just watch the massive lobbying efforts that will coalesce to fight against this newly-found plunger from being used to fix an enormous problem.

The legal question will most likely center around whether this new transparency initiative violates contract law, or whether it can ‘bust’ antitrust activity that harms the public. The insurance card that we carry represents lost wages and financial bonuses that have, instead, been unnecessarily diverted to pay exorbitant healthcare fees to others.

A Possible New Beginning – More Changes Necessary

By itself, having real prices become publicly available will not solve the inherent problems that persist throughout the healthcare system, but it may serve as the liquid drain cleaner that will eventually loosen stubborn ‘hairy gunk’ that blocks a drain from functioning properly. Price transparency is a good first-step to have, but it is not the sole remedy to a ‘system’ that requires massive fixes.

Despite isolated progress, healthcare ‘consumerism’ has been relatively slow for various reasons. However, by exposing real (negotiated) prices to the public, the aggregation of price data will most likely find new legs due to third-party entrepreneurs and technology companies who will find clever ways to make pricing a relevant decision-making tool for many patients. This has always been the hope for consumerism to take hold. All purchasers want the BEST VALUE in the healthcare being purchased.

Unclogging the healthcare price drain will begin to allow for a natural flow of the real waste to exit the system.

To stay abreast of employee benefits and healthcare issues, we invite you to subscribe to our blog.