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Anthony Guerra
Anthony Guerra

Guerra On Healthcare: HIMSS Buzz Doesn't Square With Reality

The top trends seen at the leading health IT conference -- accountable care organizations, payment reform, medical homes -- are far removed from the real issues confronting CIOs in the trenches.

First off, let me extend my sympathies to those of you who ended last week as tired as I was. Healthcare Information and Management Systems Society (HIMSS) is THE healthcare IT conference of the year and one must not leave any potential meeting, exhibit hall visit, or networking event on the table. As such, we all start at 7 a.m. (which means getting up at 5), end at 11 p.m. (which means getting to bed around midnight) and go full speed during the hours in between.

After four days of that schedule, I was ready for a little R&R, though I'm not sure being handed a 2-year-old upon arrival (after which my wife abruptly disappeared into the recesses of our home) was quite the recipe for recovery I had in mind.

But despite the slowly abating fatigue, it's time for some post-HIMSS analysis. During the show I was continually asked: "What are you seeing?" and "What do you think are the main trends here?" After giving what was probably the most common answer, "Accountable care organizations (ACOs), payment reform, patient-centered medical home," and the like, I began to think about why those answers were so common. Perhaps those issues did constitute "the buzz," but not all buzzes are created equal.

There are, you see, two types of buzzes -- grassroots and artificial.

Grassroots buzzes are real, they bubble up from the trenches. Those are the buzzes I hear when reflecting on the interviews I do with healthcare CIOs every week. Then, there are the artificial buzzes, much like the white noise I listen to on my computer to block out background distractions. Artificial buzzes are created by someone or something. They, in turn, break down into two types -- nefarious and well-intentioned.

I believe that the buzz around ACO, patent-centered medical home (PCMH), pay for performance (P4P), and the eventual demise (at least diminution) of fee-for-service payment models is the result of a well-intended artificial buzz created by conference organizers through their selection of speakers and educational sessions.

I arrived at this conclusion because, no matter how many times I told others what the buzz at the show was, it just didn't square with what I'm hearing straight from CIOs during our interviews. While the buzz at the show was ACO, the fight in the trenches is Stage 1 meaningful use.

"What about Stage 2, ICD-10, etc.?" you ask.
"Barely on the radar," I say.
"No bandwidth."

Healthcare CIOs find themselves in a triage-like situation today where the fire du jour is just about all they have time for. Except for the largest of the large, it's "get through today and we'll worry about tomorrow when the sun comes up." That's a tough world to live in, but it's the one every agency which has piled on regulation after regulation, program after program, has brought about. It's all too much, too fast, it's all far too complicated and exhausting.

The only way this works out to any degree of satisfaction is if the government does a darn good job of crafting meaningful use, so when healthcare providers finally get to look up at what payment reform will require, they have all the technologies in place to make it happen. Physician quality reporting initiative (PQRI), meaningful use, and ACO (with its bundled payments and incentives for quality) must all work together seamlessly because there'll be no time or resources to turn the ship before the next dynamic takes hold.

So that's my two cents: the imposed buzz at HIMSS was around ACOs, payment reform, and quality improvements, but the buzz on the streets is no more than qualifying for Stage 1 meaningful use payments. To get those payments, providers are still grappling with the regulations to understand exactly what they require. Yes, we're still at that stage.

But artificial buzz should not be dismissed out of hand because it can get us thinking about the world of tomorrow. And, where possible, we should do what we can today to be ready for that world. Just as importantly, the buzz of tomorrow must not be confused with the reality of today.

As I've written before, the government, thorough meaningful use, is now crafting the five-year strategic IT plan for every hospital and physician practice in this country. They wanted it and now they've got it. The government, through CMS, is also going to craft payment reform. To a certain degree, sadly, we've all becomes spectators in a game that will define our professional (and to an extent, personal) world. Let's just hope the people orchestrating it take today's realities into consideration when building the world of tomorrow.

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Anthony Guerra is the founder and editor of, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected].

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