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EMRs, Small Business and Universal Coverage

Posted on July 28, 2009 I Written By

I turned on the radio on Monday and they were talking about Healthcare again. Universal coverage, the August recess, the “blue dog” democrats.

I keep thinking about how EMRs fit into all of this. Obama thinks that EMRs are going to make care better, more efficient and less costly. I think he is right about the first two (if we install EMRs that are usable and bring value to doctors and patients), but not necessarily about the third. EMRs may not reduce costs!

As Obama takes our economy (and our healthcare system) away from the small business model to the big government/big business model, I wonder how EMRs fit into all this. Investing in an EMR is a big deal for most physicians because we are a small business that provides medical care. Spending hundreds of thousands of dollars on an EMR which may not bring return on investment (ROI) while potentially reducing our productivity is a big risk. At the same time, if reimbursement are reduced or the system becomes Universal, the stakes are higher and the risks are greater.

Everyone (individuals and small business) is struggling with our current economy. Small businesses are at risk (many are closing their doors). Physicians are working hard to pay the bills, make payroll and have a little left over to take home to the family. The EMR issue has to be handled correctly or it could have dramatic effects on our healthcare system. The EMRs have to be effective and efficient. Doctors have to like them and be satisfied with their utility and performance. EMRs have to help us take care of patients more effectively and efficiently. Anything less than this throws more sand into the cogs of the healthcare machinery and amplifies the risks of all the other changes occurring at this time.

Inertia in Healthcare Is Sometimes a Good Thing

Posted on July 21, 2009 I Written By

President Barack Obama is defending his relentless campaign for a health care bill before Congress’s August recess, saying “the default in Washington is inaction and inertia.”

Mr. Obama, there is a good reason for inertia. It protects complex systems which have evolved over time from dramatic change which can be very disruptive and threaten the very survival of the system. Inertia moderates change so that change can be accomplished slowly and successfully. Inertia is sometimes a good thing. In the case of healthcare reform, this inertia might save our healthcare system.

Improving our healthcare system is an important project. This cannot be done in 3 months by politicians and bureaucrats who are not expert or experienced in the ways of healthcare. The system must evolve slowly, thoughtfully and carefully.

The goal should NOT be universal coverage at the expense of everything else! Universal coverage is a worthy goal, but there are other things which are more important like quality of care, cost of care, ability to access care, innovation and properly aligned incentives. Universal coverage puts EVERYTHING else at risk and therefore we need to pause, take a deep breath and figure out how we are going to improve our health system without ruining it and putting our whole economy at risk.

The experiment in Massachusetts has been a disaster. It has achieved the goal of universal coverage but the cost of care has gone up and access to care is terrible (not enough providers). Doctors are miserable, not making any money and they are leaving the state. Let’s look very closely at Massachusetts before we duplicate this disaster at the national level!