Frocket. A Frat-Pocket. The very fratty pocket on the front of the shirt, typically worn by Fratdaddys or Sorositutes. According to the Urban Dictionary, a common misconception of the meaning of Frocket is the front-pocket.
I like using the misconception of words like Frocket as an analogous to terms like the Patient Protection and Affordable Care Act. (We’ve shortened it to the Affordable Care Act probably because we have been leaving out the Patient Protection part. Perhaps we should add to the name and call it the Patient Protection, Affordable and Patient Accountable Care Act.)
Between the Supreme Court verdict, the re-election of President Obama and even with the past mid-term election which gave the Republicans control of both houses, it seems clear that healthcare reform is here to stay. Tweaking and changes yes, but repeal, no.
Forward and faster with the ride.
In a 2013 issue of the Memphis Business Journal, I was one of three individuals interviewed for the article, “OVERHEARD…” in which I said, “So many things have yet to be defined. When you think of how much capital the providers have put into (reform efforts), for example, you have to ask how they can afford to put even more in without knowing what the federal government is expecting. If you thought the past year was bad, 2014 is going to be bloody.
If we had looked beyond 2014, what would have followed? One thing for sure, political and ideological affiliation continues to divide our country.
During 2014, I have been critical of:
The Obama Administration was obsessed with healthcare reform policy, but oblivious to the details of implementation. I can’t leave out both Democrats and Republicans in Congress regarding being oblivious to implementation. But does it really surprise us with 43 percent of Congress being lawyers? More on this later.
CMS has done more to add to the costs of healthcare with hurdles and regulations and both HHS and CMS rely too much on processes and not on outcomes. Again, I don’t want to leave out Congress when talking about processes and outcomes. This is obvious.
Process upon processes with a changing target, there can be no positive outcomes that patients and providers have and are facing. There are plenty of deviants in the political process to keep changing an undefined target. (Deviants are simply individuals who differ in many aspects from the larger flock of society...Urban Dictionary)
As I mentioned in my December column, in the book Systems Thinking Basics, Virginia Anderson and Lauren Johnson define systems thinking as a “holistic and big picture view of the whole. It is recognizing the interconnections between parts of a system and synthesizing them into a unified view.” Are we ready to accept unified/united to make the new paradigm work?
This is what I am thinking: HHS/CMS will come under more scrutiny concerning the way they do business. Ripping out and tearing down silos that add layers of processes with no definitive outcomes. Hopefully, with the change in leadership in the Veteran Administration we may have a business model to emulate.
Hold HHS / CMS accountable. There is discussion now to give CMS more authority to fine providers without having to go through, as HHS/CMS says, “the expensive and time consuming due process audit.” I guess with the results of the different Medicare/RAC audits through both internal employees and contractors, which have been dismissed, thrown out, etc, I would be looking for a non-transparent way to have my cake and eat it too.
In a 2014 article, “CMS Hasn’t Got a Clue!” Medical Economics, Memphis Medical News, I quoted Melvin Kranzberg, who said, “This year is expected to be a watershed year in the area of information technology (HIT). Technology is neither good nor bad, nor is it neutral.”
Alongside challenging HIT reporting programs such as Meaningful Use II, ICD-10 implementation, are significant administrative simplification (for who?) opportunities with new standards and operating rules.”
I recently spoke to a friend and colleague, Robert Tennant, senior policy advisor for MGMA Government Affairs who had just returned from a panel discussion on interoperability. He said for all practical purposes it looked as though Meaningful Use II had ground to a halt. In Stage I Meaningful Use, 90 percent of hospitals and 75-80 percent of physicians were prepared for Stage I. Less than two percent of both hospitals and physicians were prepared for Meaningful Use II.”
Much of this is due to changes made in Stage II which impacted Stage I which still has not been meaningfully defined. This most likely will cause another delay in Meaningful Use II and the implementation of ICD-10.
Tennant said, “Even if providers were prepared for Meaningful Use I and II, there would still be interoperability issues. The data required has more than 500 data points and would overwhelm us with all the information. He refers to a new concept, Targeted Interoperability, which means useful, actionable, reliable and standardized. In my simple mind, I compare that to all of the useless, time-consuming emails that I have to decide whether to read, save, or delete.
Members of the House Energy and Commerce Committee issued a report last year, saying health information technology would be “unable to truly transform our health system unless they can easily locate and exchange health information.” Spearheaded by Rep. Michael Burgess, R-Texas, House members said, “More must be done to bolster interoperability nationwide. Adopting these standards by 2018 is reasonable and should be the highest priority for the Office of the National Coordinator for Health Information Technology (ONC). The office of ONC seemed to agree, with its new chief, Karen DeSalvo, MD, calling interoperability the “Top priority for 2014” earlier this year.
HHS Secretary Sylvia Mathews Burwell, in October appointed DeSalvo to serve as acting Assistant of Health, effective immediately. She will serve as acting Assistant of Health, while maintaining her leadership of ONC and continuing to work on high-level issues at ONC and will follow the policy direction that she has set. She will continue leading the development of the interoperability road map and remain involved in meaningful use policy making.
I am not sure what type of medical degree she has, but I hope Dr. DeSalvo’s medicine bag is full of medicine. I think Dr. Joseph Schneider, chief medical information officer at Baylor Scott & White Health in Dallas, was more articulate with his concern. “DeSalvo is trying to handle two demanding jobs at the same time, which seldom has positive outcomes for anyone. If you give people too many things to do, they don’t get it done terribly well.”
Just like Ollie said to Stan: “Well, here’s another nice mess you’ve gotten us into.”
Bill Appling, FACMPE, ACHE, is founder and president of J William Appling, LLC. He is a national speaker, presenter and a published author. He serves as an adjunct professor at the University of Memphis and is on the boards of Hope House and Life Blood. For more information contact Bill at j.william.appling@outlook.com.