Could Obamacare Fail?

How Obamacare Could Fail

One of my non-scientific methods of gauging the current state of the health care system is by the requests I receive for writing and editing.

For example, I have recently received four requests to write about failed electronic medical records systems (no surprise there).  Others include the progress of accountable care organizations (ACOs), the future economics of physician groups, compensation models for physicians, hospital/physician relations and new regulatory issues for nursing homes.

So all of this gets me thinking; what could happen to create a catastrophic failure of Obamacare?  My thoughts….

Accountable Care Organizations:  ACOs could fail to work as hoped by the feds, this could collapse the foundations of Obamacare

Failed integration efforts: hospitals and systems are integrating multiple services, creating much larger and much more complex organizations, not  all of them will work

Exchanges:  the shopping experience becomes a confusing mess (high probability IMHO)

Payment Innovations:  innovations such as fee bundling fail to be feasible

Employer meltdown:  employers engage in wholesale dumping to the exchanges (not impossible in such a weak economy)

So, what are the odds of catastrophic failure?  50% - 50% in my opinion.

Tom

BYOD ...... BYOD?

BYOD

Bring Your Own ???   Device!

Smart phones, netbooks, tablet computers - never before has such processing speed and huge storage capability been available in such small packages.

Many physicians and practice staff members are bringing their own devices to work, and filling those devices with all sorts of practice data.

Which creates problem.

HIPAA privacy. HIPAA security. Both can be easily compromised.

Practices must set policies and procedures designed to control the transfer and use of PHI.

Practices must set policies and procedures  to control the use of phone cameras.

Practices must be worried about HIPAA privacy and HIPAA security.

EMR - Salvation or Meltdown?

In the past we have predicted the EMR focus of the Obama administration might not work as well as intended. Sadly, and many billions of dollars later, I may be correct.

(The New York Times has run many pieces on this, the latest on the hard copy business page on 1/11/2013.)

And next year we make the ICD-10 conversation, sort of throwing gasoline on a raging fire.

There are a multitude of problems:

Too many vendor systems, making EMR to EHR linkages difficult

Crazy long and complex federal regulations

The input devices irritate physicians and disrupt the flow of the office practice

Medicare thinks EMRs are inflating billings, due to text cloning and auto-coding

The hospital and nursing home systems are often distractions to nurses

Going totally paperless is largely a myth so far

HIPAA security issues abound

So where will EMRs work? Based on recent observations perhaps in very large integrated systems where every provider is on the same system, although some of the front line personnel are singing the same sad songs as others.

E-prescribing may be one area with some success.