Health IT should be a bigger political issue
Even for those of us who lean in one political direction or another, we should all agree that elections should involve a robust exchange and debate of ideas. It should be about choosing between two candidates based on not only character, but policy goals and who reflects a grand vision.
Anyone involved in healthcare should care about what politicians say with regard to big picture issues such as Medicare reform, and smaller subsets such as quality measurements, bundled payments or telehealth.
Which is why a primer from the Council of Accountable Physician Practices this week detailing topics it wanted politicians to focus on this election cycle felt charmingly retrograde and almost naive. I wanted to pat the group on the head and say, “Oh, this is adorable. Now excuse me while I go catch up on the latest political Dumpster fire.”
Neither presidential candidate has spent much time talking about issues such as value-based payments, health information technology coordination or quality measurement, CAPP chairman Robert Pearl, M.D., told Bloomberg BNA this week.
“Both candidates have commented on the exchanges and the price of drugs, but there hasn't been a discussion about the big changes needed in healthcare,” he said.
I think we can agree the chances of the next two months involving an intellectual discussion of the intricacies of healthcare policy within the current political spectrum is nil. But those of us in healthcare media wouldn't be doing our jobs if we didn't at least try to engage with what the future holds.
One of the most interesting parts of the CAPP primer relates to telehealth and health information technology (HIT) interoperability. While Democratic nominee Hillary Clinton's plan to address mental health was drowned out this week by Trump running to Mexico, her plan calls for Medicare and Medicaid payment systems to adjust for telehealth services and telepsychiatry to be reimbursed. That's good news for long-term care providers, especially those in rural areas, who struggle to find appropriate providers for seniors with mental illness.
In fact, there's some evidence that telehealth may work better for certain seniors, as they may be more comfortable talking via an iPad than visiting an office. Trump has said his plan for Department of Veterans Affairs reform includes more telehealth for veterans. To its credit, the VA has already done more than two million telehealth appointments in 2015, according to BNA.
What is trickier is CAPP's request to demand interoperability of HIT systems. The federal government has invested $30 billion since 2009 for providers to purchase HIT, but long-term care has been notably left out of incentive programs. I agree with value-based reimbursement and the push for care coordination via bundled payments. But I believe the government forgot a critical piece to how care coordination works, which is that electronic systems need to talk to each other. If part of the point is to limit duplicate tests and imaging, we have to start comparing apples to apples.
Similarly, few people would disagree with CAPP's assertion that quality measurements should be standardized. Providers are producing hundreds of duplicative measures addressing similar issues with different methodologies, CAPP notes.
If there's anything overarching I took away from the LTPAC HIT conference this summer, it was how much CMS wants interoperability. I spent hours listening to very smart people talk about the technical challenges involved. It all comes down to making sure the right decision-maker has all the information available before he or she prescribes a medication, recommends a discharge or orders more tests.
We often think of faceless bureaucrats in Washington, DC, making recommendations that make your lives harder, and there's a certain truth to that. But I also can assure you there are a lot of people pushing for a system that makes sense. We can only hope the next administration gives them the support that they deserve.
Follow Elizabeth Newman @TigerELN.