AskTheExperts

How can you stay current on a changing financial landscape shaped by incentive payments for hospitals and physicians and also keep C-suite leaders decision-makers informed?

There is no single answer to this question. The combination of trade journals, e-mail blasts, webinars, podcasts, local seminar attendance and national conference participation is a good start. So would be, the need to educate your Governing Body and senior leadership teams. This is the time for CIO’s to stand up and be heard! Incentive payments are forthcoming for those organizations positioned to take advantage of their years of hard work and effort to build infrastructure into their facilities. For those that have not kept up, they may find themselves unable to reap the benefits—whether it be lack of funding, scarce technical staffing, access to system upgrades or just long lines of other facilities already in queue with vendors for upgrades and installation projects. If you’ve been stuck in second gear in a late model car, you may find that the accelerator may stick, your engine may sputter, or worse, seize, as you are asked to go full throttle to meet the deadlines for ARRA and HITECH. Get on the agenda and make a difference for your patients and community NOW.

Since budget reductions are being made across the sector in response to the trying economic times, is it wise to slash education and travel budgets given the steep learning curve for ARRA and HITECH rollouts?

Across the board reductions of expense line items such as Education and Travel have been de rigueur for financial teams for years. It’s easier to cut “controllable expenses” than people or a program is the mantra. Now, with the ARRA and HITECH funding hanging in the balance, IT professionals need to stay current more than ever. As organizations struggle with salary freezes or reductions, benefits changes, reductions in force, layoffs, hiring moratoriums, the true answer lies in an overall look at current ability and making sure that as the recession recedes and funding streams come on line, you are able to respond. It is an art, certainly not a science to strike a balance between short-term funding and longer-term survival. However, one can argue that now is certainly not the time to restrict thought leadership access for IT professionals.

Will the lack of a visible name in leadership at the Department of Health and Human Services mean delays in relative progress to move the industry forward?

The optimism of a recent appointment announced was exceeded by the balloon bursting with a sudden withdrawal. Out of this comes another prolonged period of uncertainty for the direction of our industry sector. Legislation, regulation, funding allocations between the federal government and individual states, and a host of other implications all hang in the balance of a new appointment and their confirmation process.  Healthcare is a business, and like all other businesses, we are hurting. No longer viewed as  ”recession proof”, we have seen the tip of the ice berg with layoffs, cost of living adjustment deferrals, collective bargaining concession, and even receiverships or bankruptcy filings. The Obama Administration knows the importance of health to the local economy and must match the rhetoric with a replacement that “gets it” and then gets on with it as soon as possible.

The economic stimulus package is upon us – what does it really mean to healthcare?

Billions of dollars are headed to healthcare in the form of awards for electronic investments in physician offices and hospitals.  Some $45 – 65k is targeted for physician offices that make investments in electronic records and some $2M per hospital is also to be funded.  While laudible for patient safety, quality of care, and clinical documentation for payment reasons, will it really make a difference in the overall economy is the question of the hour.  “Shovel ready” projects are all the rage.  Folks that have delayed Strategic Planning or postponed Search and Selection processes are certainly behind the times.  While the money pressures have certainly focused facilities to maximize legacy investments, without a concerted System Optimization effort, those may not be enough.  Further, with the staff reductions, particularly in overhead expense areas like IT departments, Staff Augmentation needs for any sizable project or investment may need to be considered.  In short, this money is not free and will not come on a silver platter. Now is the time to re-focus your IT strategy.

Information Governance: will breaches be enforced?

The federal agencies have long spoken of enforcing breaches, but only one is on record to date. The fear does not seem to be the burning platform that HIPAA implementation was 5 + years ago. Routine audits are conducted, no new ground seems to be broken by institutions to assess their vulnerability. Information Governance umbrella HIPAA, related state statutes, identity theft, credit protection, and the like. It is the essence of public trust: to maintain their confidentiality as the workplace has evolved from paper to electronic. Have you tested your system lately? You probably should.

Healthcare IT: where will the funding come from?

The Office of the National Coordinator for Health Information Technology was established in 2004. A truly unfunded mandate, there was an Executive Order that limited the federal funding for this vital office. Before even assuming office, President-Elect Obama has received a funding request of $25B from the Healthcare Information and Management Systems Society. Mr. Obama has already gone on record in favor of committing $10B over a five year period for healthcare IT. Vice President-Elect Biden has spoken about these funds being made available in an economic stimulus package soon after the swearing-in. Proponents of healthcare IT are truly banking on these promises, and patient care improvements await these expenditures.

The Obama Administration appears to be serious about healthcare reform, what can you predict?

Change of some sort, but certainly a flurry of activity. Think back to the Jackson Hole Study Group headed by Hilary Clinton in her husband’s first term. While nothing came out of their efforts to nationalize health care, the mere focus on the policy effort caused managed care plan reform, health care systems to be formed, physician groups to come together, and  state governments to propose local changes so as not to be swept up in the federal matching dollars no longer coming to them.  The recent “successes” of coverage for all citizens in states like Massachusetts present a carrot for liberal lions like Ted Kennedy to leave his legacy in Congress with sweeping change on the national front.  A cold and hard look at the cost overruns, underestimates of the potential enrollees, and impact on previously funded “uncompensated care pools” has certainly been a stick to the state as it faces budget reductions, and more importantly to providers, especially Safety Net Hospitals.  Revenue issues will plague the federal efforts well into the first term for President-Elect Obama.  So, expect more unfunded mandates.

With all the main stream media and press coverage of security and privacy breaches, what should health care organizations be doing to prevent potential regulatory enforcement?

We’re seeing clients across North America dust off their HIPAA policies/procedures and related state regulations with renewed interest.  Identity theft, hacking, and paper records are presenting real cultural problems for facilities.  It’s been 5+ years, and folks are lax in their discipline to protect routine information.  Just sit and listen in waiting rooms or registration areas if you want a sample.  Anecdotes become data.  The better positioned clients have taken a fresh pair of eyes approach to annual audits and developed an Information Governance Committee to look at all aspects of privacy and security.  Information Governance may be a new term in the states, but it is widely known in the United Kingdom where the roots of privacy protection began more than a decade ago.  Information Governance umbrellas HIPAA, Red Flag Rules, state statutes, and the like and really focuses facilities on the number of potential breach points that e-health records, paper bills, associate agreements, etc. present to today’s evolving care delivery systems.

How will healthcare look beginning January 20, 2009 with either new administration?

Both candidates, and their parties, have different and divergent views for the reshaping of healthcare. Simply stated, one is for big government and one is for market forces. Sadly, there is no magic bullet and the only silver lining in the offing will be hard-won, bi-partisan support for a consensus reform effort that Americans can get behind. Medicare funding is lagging as more seniors qualify for coverage every day. The economic downturn will likely exacerbate the state’s support for Medicaid programs. And with businesses taking on water and feeling the effects of the rising tide of health insurance double-digit increases, the cost-shifting to already stressed employee earnings will continue to hurt any economic stimulus package. Both leaders have healthcare in the their respective top five platform messages, unfortunately, the war and the economy are number one and two for each and these may exhaust the resources available and diminish other reform efforts.

The economy in the Fall of 2008, what does that mean for health care?

Recent studies touted that one-third of hospitals are in the red, one-third are living off investment income, and one-third of facilities are in the black. The recent nearly 800-point drop on Wall Street (followed by a 500-point rebound the very next day) certainly highlights the precarious nature of the dependency on “bottom-bottom line” earnings for future growth, or at least continued survival.  This certainly is not the “Go Go 80s”. Organizations now need to look to their Governance for leadership on their Investment Committee (or similar) to right their financial investment strategies and implement new and better short-term tactics. More than ever, the need to control the controllable, and aggressively monitor day-to-day operations should be top of mind with C-Suite executives and be the priority focus for front line supervisors.