I like my independence, which is perhaps why I started my own company earlier this year. Sure, in a sense, I work for my customers, and they essentially take the role of my former bosses, but it really is quite different. When you have a boss, you don't get to say no (without usually suffering some serious consequences down the road), but when you have potential customers, you can say no to a proposal that does not square with your overall business plan and philosophy.
I have written before about this idea of "staying within your box" as an important factor in success, and it comes into play again here. Unfortunately, Meaningful Use (MU) has taken many healthcare organizations outside their box, in the sense that attempting to qualify for its incentive funds is forcing them beyond their capacity, much like an old train shaking as it reaches top speed. More disturbingly, the quest to qualify for its funds will require them to go ever faster.
When you go all-in on a government incentive program like Health Information Technology for Economic and Clinical Health (HITECH), you've just taken on a new boss, one who can call the tune to which you must dance, and change that tune as often as it likes. But let's remember two things about the program before we move forward. First off, it is voluntary, both in the sense that you don't have to do it and also in that you don't have to accept Medicare/Medicaid patients at all. The government is the payer, and that payer has been voluntarily accepted by your organization.
Second, remember that since the program is of such a voluntary nature, the government gets to determine exactly what you must do to receive the money if you should choose to participate. In a recent clarification which has produced some outcry, Blumenthal stated that yes, you must buy (but not install) all MU-related electronic health record (EHR) modules now, whether or not you plan to use them in qualifying for Stage 1 monies. Remember, he who offers the incentive gets to make the rules.
One of my healthsystemCIO.com bloggers, Paul Roemer, has consistently written about the dangers of outsourcing your strategic plans to the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS) for a return which amounts to pennies on the dollar, but just about every organization in the country has done it. Now, some are bristling at the twists and turns MU is taking, and I have no doubt they will continue to do so for two reasons. First off, those making MU policy will continue to want more for the money they're laying out. Secondly, healthcare providers far down the HITECH road will realize they have no choice but to continue stretching for the carrot which dangles on the ever just-out-of-reach string ahead.
What comes to mind here are expressions such as "there are no free rides." For those who thought qualifying for MU would be a jolly good time, I guarantee you this unpleasant clarification will be the first of many sobering moments. By jumping aboard the MU train, you've inadvertently taken on another boss, called the U.S. government. The government's representative, in this case, is David Blumenthal, whose recent holiday letter has left many in a less-than-festive mood.