Healthcare IT has generated a lot of press coverage lately, but to hear providers tell it, HIT does not generate enough coverage (or reimbursement) of the Medicare kind. It's fun to speculate that more reimbursement might lead to less media coverage because more jingle should fix the problem, but it hasn't worked out that way to date.

When sharing goes horribly wrong

Don't tell your school-aged children that sharing doesn't always yield the desired bonhomie, but the latest final rule for shared Medicare savings for accountable care organizations is interesting in several respects, including that it may prove to have the shelf life of sushi. Makers of medical devices may find disturbing that ACOs participating in a new track under the ACO shared savings program will have two 75% incentives, one for the return on the savings investment, and the other the losses an ACO has to cover. Will that lead docs to stint on care and underutilize devices in the process?

Granted ACOs have two other tracks if they want to sidestep this high-risk/high-reward universe, including a low-reward track that provides no penalties for failing to hit benchmarks. The Centers for Medicare & Medicaid Services advised participants in this track 1 that they can re-up for another three years rather than migrate to either of the other two tracks, both of which carry penalties for not bringing down costs.

One ACO association (remember, there's an association for association executives in Washington, so don't be surprised that there's an ACO association) opined in a statement that the rewards for doing business in the no-risk track aren't juicy enough to propel ACOs into track 2 or 3, an observation that seems suggestive of a peculiar blindness for behavioral economics.

Nonetheless, that might not be the principal reason the meaningful use program will end up stalled.

Speak loudly and carry a Nerf bat

No one will ever confuse Sen. Bill Cassidy of Louisiana with an outlaw cowboy played by Paul Newman, but the Cajun senator threatened to get rough if need be to fix the laggardly progress toward electronic health record interoperability at a June 10 hearing. But that wasn't the real story.

Indeed, the hearing was at least in part a response to the hue and cry that meaningful use standards are making life miserable for Medicare providers. Sen. Lamar Alexander, who chairs the Health, Education, Labor and Pensions Committee, said he has heard from providers who say they are "terrified" of meaningful use mandates, which are apparently seen as ham-fisted and requiring more than current software offerings are capable of producing.

Alexander indicated a preference for measures that gently ease the transition into interoperable EHRs, thus providing the flip side to Cassidy's more aggressive tone, but the interoperability issue has dogged the world of HIT for roughly a decade now. Not that I'm advocating anything in particular, but one has to wonder why 10 years are not enough for interoperability. If vendors can't respond to a very clear case of government arm-twisting of their customers, will those same vendors really respond to a laissez-faire approach?

One supposes (optimistically) it depends. After all, the taxpayer was already on the hook for more than $19 billion in HIT money as of February of last year. Pardon my skeptic's patella tendon, but if providers and software companies have learned anything about interoperability, it's that the smart player can use it to leverage media coverage into more reimbursement, and vice versa.