WHEREAS, the transition from the 31st day of December to the 1st day of January of the following year, also known as the New Year, typically marks a milestone for reflection and celebration;
WHEREAS, as many as 36% of the distinguished citizens of the United States of America feel a sense of melancholy disproportionate to what they should feel during this period of joy;
WHEREAS, researchers have discovered that a depressed mood can detrimentally influence one's health and potentially increase the risk of heart attack, stroke and cancer;
WHEREAS, cardiovascular disease and cancers are a large, preventable cause of health care expenditures;
WHEREAS, total health care expenditures are growing at an unsustainable rate, causing economic hardship for individuals, corporations and government;
WHEREAS, the citizens have duly elected federal and local officials to protect the spiritual and economic well-being of all Americans.
NOW THEREFORE
BE IT RESOLVED, that all legal citizens of the United States of America be mandated to have a Happy* New Year - that begins precisely at 12:00:01 am on the 1st of January in every year;
AND BE IT FURTHER RESOLVED, that such happiness begin retroactively to the 1st day of January in the year 2008;
AND BE IT FURTHER RESOLVED, that the definition of "Happy" periodically be revised and updated to reflect current medical opinion at the minimum of every 5 years.
*Happy = Oxford Happiness Questionnaire score of 125 or greater, as verified by a board-certified psychiatrist
An Ominous End to 2007
As with many new years, we began 2007 with a renewed sense of optimism and vigor. We eagerly anticipated personal health records, engaged consumers, free electronic prescriptions and a focused political debate on how to improve our woeful health care system.
But 12 months later, we unfortunately, and perhaps predictably, have little to show for it. Mass adoption of health IT faltered, commercial releases of eagerly anticipated PHRs stumbled, and the closure of the Santa Barbara regional health information organization exacerbated concerns that real information exchange might not be economically sustainable.
So, perhaps, it wasn't too surprising to learn at the end of 2007 that legislators were planning to mandate electronic prescribing as part of a must-pass Medicare bill. That provision potentially would have required physicians to adopt e-prescribing and threatened future penalties for those who failed to do so. In the end, the Medicare bill was passed without the electronic prescribing mandate, although lawmakers are developing a similar requirement with reasonable bipartisan support.
Many legislators and health care reformists support mandating providers to adopt specific forms of health IT. This, however, represents a very problematic direction that might only exacerbate our current health care crisis and further propel us toward failure.
What's So Wrong With Mandates?
The problem with a mandate approach to fixing our health care crisis is evidenced just by examining what is wrong with our current system. Over the last 50 years, we have tried to create a rational health care market based on centrally controlled third-party reimbursement models, payment formulas, organizational regulation, coding schemas, privacy mandates and quality surrogates. The result? The most expensive, poorly accountable, confusing "system" of care that encumbers providers from delivering what we all want: quality, cost-efficient care.
The reality is that mandates don't foster innovation, they stifle it. Mandates imply that there is only one way to solve a problem -- create secondary constraints that prohibit innovation in other equally important directions and disable competition by removing incentives for novel approaches and ideas. In addition, mandates are slow to adapt and their original intent can end up distorted. What appears to be sound today may quickly become irrational in the future.
Often, mandates focus on the wrong goals. In the case of e-prescribing, it'd be one thing if the only output we wanted from our health care system was a prescription that wasn't written on paper. If that were the case, such a mandate would be enormously successful. But, in reality, what we want is an error-free, cost-efficient health care system. Electronic prescribing may be a tool to support such a direction, but it certainly isn't the only, single tool needed. Nor is it a panacea. By forcing all providers to use e-prescribing, we may be consuming what little time and resources remain among providers and, in doing so, prevent them from addressing the problem more cost-effectively in the future.
In addition, mandates hide the real problems inherent in the system. By forcing all providers to adopt e-prescribing, we mask the real reason why e-prescribing is not being adopted today. It is not that physicians don't want safer, electronic prescriptions; they all do. It's that they don't have the time or money to invest or adopt systems that only slow them down and reduce income in a volume-based, procedure-rewarding reimbursement system. If providers had more time and money, or if e-prescribing systems were better designed for ease-of-use, adoption would more quickly follow.
An Alternative to Mandates
So, if not mandates, what other means do we have to foster e-prescribing?
The reality for most providers today is that they have very little time to think about e-prescribing, let alone other health IT initiatives. The average primary care physician today spends as much as 20% of his day doing activities that are not compensated for in today's reimbursement system. And to make up for low reimbursement, many physicians have increased the volume of patients they see per day to unsustainable and dangerous levels.
If we truly want providers to adopt electronic prescribing in order to deliver higher quality at lower costs, and if the adoption necessarily implies a moderate investment of time and money, then it's simply unrealistic and unfair to demand that overworked providers just try harder or face the possibility of financial penalties.
Rather, we should start investing in our providers and giving them the time and resources to adopt better systems of care. And then we should share some of the secondary financial benefits that result -- if there are any. We can't ask providers to bear all the responsibility and risk for change and then offer them nothing in return. Yes, this will increase our costs in the short-run, but, if we believe our own gospel, e-prescribing should ultimately lower costs in the long run. If we aren't willing to put money behind our own return-on-investment projections, then we shouldn't be asking providers to do the same.
The foundation for primary care is rapidly crumbling. In Washington, D.C., it might be easy to forget how fragile our current system of care is. But, unless we make some dramatic changes toward supporting and investing in (not mandating more restrictions on or slashing reimbursement for) our primary care providers in 2008, we'll be looking at anything but a Happy New Year in 2009.
MORE ON THE WEB
- "Congress Approves Medicare Bill Without Health IT Provision," iHealthBeat, 12/20
- "Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007" (S 2408)