As healthcare providers examine the final "meaningful use" regulations, perhaps too much focus is centered on IT system requirements and gap analysis. Hospitals must not fail to recognize a significant reality: Federal incentives for utilizing EHRs will not come close to covering the costs associated with purchasing, deploying, and maintaining them (PriceWaterhouseCoopers; April 2009). Therefore, it's imperative for hospitals to leverage meaningful use objectives not just to improve patient outcomes, but also to realize near-term cost savings.
Payers, in fact, expect to see cost reductions from meaningful use. Hospitals, too, should share in the benefits; benefits that amount to more than just a one-time incentive payment or the avoidance of future non-compliance penalties. Forward-thinking hospitals will do two things:
1. Be strategic in the implementation of all meaningful use objectives.
2. Be strategic in the selection of "menu" objectives.
One core hospital objective, for example, requires EHRs to provide patients with electronic copies of their discharge summaries. This objective offers an excellent opportunity to improve patient compliance with discharge instructions, and thus reduce preventable readmissions -- which will incur payment adjustments under the Patient Protection and Affordable Care Act starting in 2012.
Case-in-point: The Portland VA Medical Center (PVAMC) reduced its 14-day readmission rate from 4.1 to 1.5 readmissions per 1,000 outpatient procedures when it automated its process for providing detailed discharge instructions specific to each patient and procedure (Patient Safety & Quality Healthcare; Jan-Feb 2010). Those instructions--additionally saved in the EHR--include information such as the correct names of the procedure, the surgeon, or the attending physician. [One new study found only 18 percent of patients could correctly name their physician, and only 57 percent could correctly state their diagnosis (Archives of Internal Medicine, August 9/23, 2010)]. But when PVAMC patients who misplace their information contact the hospital, on-call nurses now access the EHR to retrieve the exact discharge instructions. They often resolve issues without costly--and possibly unreimbursed--readmissions.
When it comes to "menu" objectives, organizations should concentrate on those able to generate a positive financial return. Consider, for instance, two that are relatively easy to execute: providing patient-specific education resources and documenting advance directives.
Furnishing patients with comprehensive educational materials improves outcomes, and is also a well-documented mechanism for reducing preventable procedure cancellations (Journal of Cataract and Refractive Surgery, January 2006 and The Journal of Nuclear Medicine, 2008). Astute hospitals immediately recognize the benefit of minimizing revenue loss associated with cancellations, and it can be accomplished with IT systems that easily interface with existing EHRs, providing patient-specific pre-procedure instructions, education materials, drug monographs and anatomical images (Healthcare IT News, April 24, 2007).
The advance directives "menu" objective is worth scrutiny as well. One landmark study found 52 percent of Medicare payments for a patient's final year of life occur in the last 60 days (The New England Journal of Medicine, April 15, 1993). Another study shows patients who don't have end-of-life discussions with doctors suffer significantly higher healthcare costs, worse quality of life, and no increase in survival time when compared with patients who do (Archives of Internal Medicine, March 9, 2009). "Heroic" care, therefore, is sometimes neither desired by the patient nor fully reimbursed. A recent commentary (Hospitals & Health Networks, January 19, 2010) describes how the Department of Veterans Affairs has tackled the situation by employing an automated informed consent application to record patients' advance directives in an EHR.
For meaningful use to be economically successful in the long-term, hospitals must adopt a strategic approach that takes all IT functionality into account, not just the potentially narrow offerings of a single EHR. Many objectives can--and must--be implemented that will generate both near-term financial benefits and improved patient outcomes.
Timothy Kelly, M.S., M.B.A., is a vice president of Atlanta-based Dialog Medical, a provider of informed consent and patient education systems for hospitals and physician practices.
