Mandates to Enact Health Policy


Mandates to enact health policy - provide your perspective as an informatician: Do you agree or disagree with the approach of government mandates to enact healthcare reforms such as:  Implementing EHRs, ICD-10, MACRA?  What are key factors that support government providing a “helping hand” to implement new technology?  What are the factors that support a free market approach being more successful? 

Government mandates provide a foundation to work towards in order to see a substantial improvement in healthcare. The enactment of the American Recovery and Reinvestment Act of 2009 (ARRA), brought about unprecedented funding for technology in healthcare. This funding has been leveraged in incentive payments to providers to leverage technology in order to support a continual improvement of care. The initial approach was a focus on Meaningful Use put in place by the Health Information Technology for Economic and Clinical Health (HITECH) Act which provided incentives based on specific measures for using EHR's. Some of the fundamental guidelines were in place to support improvements in coordination of care, improvements in public health, and amongst many other concepts (CDC, 2017). The introduction of the Medicare Access and CHIP Reauthorization ACT (MACRA), seems more of an enhancement to the payment and incentive models that hopes to really stimulate a shift toward value-based care. A shift from solely focusing on meaningful use incentives, MACRA's primary elements are the quality payment program models which are merit based incentive payments (MIPS), and Advanced Alternative Payment Models (APMs). These two payment models promise potential reward for higher value of care which is no longer solely grounded on technology enhancements, but more data focused. This shift seems more of a focus on leveraging information to provide better quality care (CMS.gov, 2018).

EHR technology overall has had a phenomenal impact on healthcare. With the enactment of ARRA and incentive programs we have seen a significant upward trend in physicians using EHR technology. The impact is nearly a double in size trend from 42% in 2008 to 86% in 2015 of office-based physicians using an EHR (HealthIT.gov, 2017). Notably the impact of the Meaningful Use incentives to implement EHR's has had a significant impact on public health which is reflected in the data. Reporting on immunization data, coordination of care data, and prescribing data has significantly improved. Post ER discharge data has increased roughly 50% from 2012 in notifications sent to primary care physicians (HealthIT.gov, 2015). With that we can expect to see improvements in coordination of care and moreover, better quality of care being provided to patients post discharge from an ER. With the capabilities electronic health records provide physicians, as an informatician I would agree that the long-term impact technology has on healthcare will shift the industry to a more value driven industry that stimulates continual improvements of care.

Governments involvement has a significant impact on healthcare’s rapid implementation of new technology. These advancements as mentioned support a constant shift towards value-based care. The incentives provided the necessary funding needed in order to implement new technology. Without the support government provided we may not have seen the significant increases in technological advancements in healthcare. Not only has this increased advancement in technology but has also provided a new opportunity for technology enthusiast to create a new market dedicated to health information technology (HIT). With regards to the overall impact it seems to me that government involvement with adding regulatory requirements and providing incentives has been the first step in the right direction. MACRA seems to push this to the next level requiring that practitioners meet specific measure in order to avoid negative payment adjustments. Overall the mandates set in place by government are the right approach if we want to see healthcare move towards a more performance focused industry.


References:



CSC. (2017). Meaningful Use: Introduction. Retrieved from: https://www.cdc.gov/ehrmeaningfuluse/introduction.html

HealthIT.gov. (2015). Hospital Routine Electronic Notification. Retrieved from: https://dashboard.healthit.gov/quickstats/pages/FIG-Hospital-Routine-Electronic-Notification.php

HealthIT.gov. (2017). Office-based Physician Electronic Health Record Adoption. Retrieved from: https://dashboard.healthit.gov/quickstats/pages/physician-ehr-adoption-trends.php


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