How Do We Know the Health IT Program in the Stimulus Has Been a Success? Because It's Spent a Lot of Money

Photo credit: The Doctr / Foter.com / CC BY-NC-NDPhoto credit: The Doctr / Foter.com / CC BY-NC-NDHow do federal health bureaucrats know that the $35 billion health information technology program has been a success? Because it’s spent a lot of money already—almost $9 billion.

As a new report on the Health Information Technology and Economic and Clinical Health Act (HITECH), which was passed as part of the 2009 stimulus, notes, senior Medicare officials seem rather focused on the total volume of money spent as a measure of success.

The HITECH act provides incentive payments to health providers who adopt and install electronic health records systems. But the primary goal seems to be to get those payments out the door as quickly as possible.

The new report, issued by a group of Republican senators, notes that the program lacks a meaningful check on those who apply for the incentive payments. Providers simply self-report that they have met the necessary criteria—no documentary evidence necessary. The report suggests that “this would be like an individual claiming to have won the lottery but not being required to produce the winning lottery ticket in order to collect the payout.”

Medicare’s Office of the Inspector General (OIG) has warned that this is a potential problem. The OIG issued a report last year saying that Medicare “does not verify the accuracy” of the self-reported information by health providers claiming the incentives prior to payment—and even noted a few examples of providers who had reported themselves eligible, but had not actually met the requirements.

Yet officials at the Center for Medicare and Medicaid Services (CMS) did not agree with the OIG report’s conclusion that additional checks prior to payment would be necessary. Why? Because it could delay the program’s payments.

Never mind, in other words, whether the money is going to the right people, or being spent effectively. The important thing is that the money is being spent.

Indeed, officials in charge of that program have been explicit about that attitude. 

As the new GOP report notes, a senior Medicare official in charge of the health IT program has openly touted its success by pointing to the successful doling out of payments: “In the opening session of the 2012 Office of the National Coordinator for Health IT Annual Meeting, Farzad Moshashari, National Coordinator for Health IT, highlighted how much money has been spent and suggested it was the measure of success of the EHR program. He recognized the CMS staff who have helped facilitate the “$9 billion” that has been provided to states that ‘had the highest proportion of eligible [providers] paid.’”

Meanwhile, even though providers are getting paid, the program is failing to achieve one of its key goals: interoperability. It’s not enough to merely incentivize health providers to install electronic health records systems. For them to work the way the incentive program’s boosters had hoped, they also need to be able to easily communicate with each other. That’s not happening. As a study by RAND noted earlier this year, “the health IT systems that currently dominate the market are not designed to talk to each other.” Instead, they’re designed to lock providers into long-term relationships with vendors who maintain expensive proprietary technology systems.

In the end, these health records systems, which were sold as a way to reduce health costs in the long run by facilitating better record keeping and transfer, may end up costing taxpayers money. That’s because they make it easier for providers to bill more to Medicare, by assisting them with Medicare’s complex billing procedures.

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  • 0x90||

    Moon river...

  • CE||

    They're spending money up the wazoo.

  • Fluffy||

    As a study by RAND noted earlier this year, “the health IT systems that currently dominate the market are not designed to talk to each other.” Instead, they’re designed to lock providers into long-term relationships with vendors who maintain expensive proprietary technology systems.

    Wow, our Obamic masters are incredibly stupid.

    Here's a free tip for the Congress and HHS, since apparently they're too stupid to have a clue: When someone walks into your office to sell you "software", what they're selling is you being their slave forever. Unable to change the product, unable to manipulate data, unable to do ANYTHING (except maybe generate and export a few worthless fields to Excel) without the vendor controlling the process and charging you for it.

    If you want "interoperability" you don't talk to software vendors, you talk to SQL DBAs and web designers.

  • Brett L||

    I'm doing an integration right now between approximately 5 systems and M$ CRM as a frontend for an ACO. Its my 7th day on the job, so I'm not fully up to speed, but the first 6.5 days have convinced me that this is going to be a big cluster of fuck. Our goal is to keep the shit from splattering on us. I've seen diverse user requirements for "33 metrics for ACO Patients". They keep telling us that they are buying yet another system to crunch numbers on metrics, but I have a sneaking sensation that someone is going to have to do that in the existing software environment. Please God, let that cup pass from my lips.

  • Paul.||

    Pray for a takeover and subsequent layoff.

  • Brett L||

    I'm 3rd party to the ACO, so, frankly, as long as any data that reaches my system gets to CRM, I am fulfilling my contractual obligations. Nobody asked me to evaluate their entire system for success. I do that for my own entertainment on the side. I just fear the idea that if our shit works, they'll keep asking us to do more until it eventually doesn't.

  • itsnotmeitsyou||

    Ahh, the burden of competence.

    When I was doing development at an office I worked at, I dreaded hearing "you can program it to do that?"

    FUCK! Now they're going to dream up all sorts of retarded shit they think is related or easy.

  • ||

    The most terrifying phrase at my place of business is "I have faith in you" followed closely by "I'm sure jesse can do that, he can fix ANYTHING"

    Mind you this has more than once involved me routing around proprietary parts to temporarily fix something and telling them they need to call in a service technician to do a proper job, which they never do.

  • Paul.||

    The most terrifying phrase at my place of business is "I have faith in you" followed closely by "I'm sure jesse can do that, he can fix ANYTHING"

    Be careful, it's not a compliment, it's a setup.

    Doing one career as software developer, then layer 1 in the networking side and now just general IT 'stuff', I've spent my adult life fixing everything that runs on electricity. Because software... or something.

    That 'compliment' is a nudge to make you take something that is so far outside of your responsibility, and so inside their responsibility to pursue, but simply don't want to. Because electricity.

    Fuck. Don't get me started.

  • itsnotmeitsyou||

    Paul, I feel you, buddy. I think that's just a general misconception about "computer people". It's like all black people knowing each other...

    Hey, you fix computers and do a bit of coding. You can fix the air conditioning, right? it runs on electricity and I think it has a computer in it somewhere.

  • ||

    it's not a compliment, it's a setup

    Believe me, I know. I have coworkers coming in and telling me their light bulb burned out, or they have a paper jam in the copier, or they've forgotten the password on their answering machine.

  • Brett L||

    I have coworkers coming in and telling me their light bulb burned out, or they have a paper jam in the copier, or they've forgotten the password on their answering machine.

    And yet, if you leave all salary information for you company in a password protected folder, they turn into first-rate fucking hackers, and everyone can remember THAT password.

  • itsnotmeitsyou||

    Hahahaha, Yeah. Oh good times. GRRRRRR

    I once told them that doing something wasn't actually possible for a computer to do. (it had something to do with subjective decision making). They just smiled at me and said "you've figured out how to get around other obstacles, you'll figure this one out"

    Guess I'm supposed to invent AI now.

  • Lord Humungus||

    I wasn't even hired as a programmer - but once they found out that I could, suddenly I was doing two jobs for the price of one. Hurrah.

    (I was hired as an EDI Coordinator)

  • Paul.||

    I wasn't even hired as a programmer - but once they found out that I could, suddenly I was doing two jobs for the price of one. Hurrah.

    that's how IT works. Interesting side note, though.. I've been joyfully underpaid for most of my career because I don't like to job hop. I (and a couple of my colleagues) came to a conclusion: The reason they're happy to have their senior software developer, or their top network engineer fixing a USB mouse is because it's not costing them six figures to do so.

    If I were paid what most of my industry counterparts were paid, they'd put a stop to that in a second.

  • Paul.||

    I just fear the idea that if our shit works, they'll keep asking us to do more until it eventually doesn't.

    That's what's known as customer-driven software development, and why I'm not in it anymore.

  • Zeb||

    If I learned one thing from Sir Humphrey Appleby, it is that government agencies measure their success by how many civil servants they employ and how much money they spend.

  • Paul.||

    Providers simply self-report that they have met the necessary criteria—no documentary evidence necessary.

    Not sure where this is coming from. I'm not personally involved in the meaningful use programs here at my organization, only tangentally. But there's a saladspinner of fuck in regards to the amount of documentary evidence that we have to build to prove "meaningful use" to receive those federal dollars.

    Maybe we're just honest. But I have to assume that those reports we produce and send off are at least nodded at by some federal official.

  • RBS||

    But I have to assume that those reports we produce and send off are at least nodded at by some federal official.

    Why would you assume anything?

  • Paul.||

    Because our org just missed a meaningful use deadline and we gave up $9.2 million in federal dollars, so someone who looks at those reports didn't get a look at them, so no check.

    Make no mistake, the meaningful use program is completely stupid and... useless. But I don't believe it relies solely on self-reporting.

  • Brett L||

    Yeah. That's not how it works in FL. I know for a fact that FLDOH has a person to examine EHR/ELR usage between labs, hospitals, and the state system w/r/t whether there is actual meaningful use work being done. I used to sit in the cubicle next to his 2 jobs ago.

  • CE||

    When you measure the health of the economy by total spending from any source whatsoever (taxed, borrowed, stolen, or earned), every stimulus dollar is self-evidently a success, even before the multiplication factor is factored in!

  • ||

    As a new report on the Health Information Technology and Economic and Clinical Health Act (HITECH), which was passed as part of the 2009 stimulus, notes

    Clearly it's time for someone to implement the Funding Ultimatum: Cancel Unnecessary Taxpayer Suffering, Promptly Eliminate Nonfunctional Dollars IN Government Act.

  • Enough About Palin||

    Worst alt-text ever.

  • ||

    If Counterfly and nicole show up it could generate quite the interesting commentary.

  • itsnotmeitsyou||

    Hey, I'm kinda offended you forgot about me.

  • ||

    It's not that I forgot about you, it's just that Counterfly and Nikki get things going, and AD would be useful too to squeal like an offended tween. I fully expect you to come in and win at the end.

  • itsnotmeitsyou||

    AD's squeals are entertaining, aren't they. Wait, that sounded dirtier than I intended.

  • ||

    I didn't realize you had a "dirtier than I intended" category.

    One of my coworkers brought up Deliverance yesterday, so squeal definitely is doing double duty in my head right now.

  • itsnotmeitsyou||

    I think, at least subconsciously, that its all "as dirty as I intended", but sometimes it just comes out dirty.

    See, I did it again.

  • ||

    You're needed in here itsnotmeitsyou.

  • itsnotmeitsyou||

    See, I saw that as dirty too... I am glad I didn't just click on a picture of your ass...

  • ||

    I don't know that I'm that comfortable with the Reason commentariat. Although through a series of unfortunate events, the little old Asian mother of a close friend saw just such a picture when we were all on vacation together. She still tells the story to anyone who will listen whenever humanly possible.

  • itsnotmeitsyou||

    Hahaha, at least she has a sense of humor about it. An ex girlfriend's mom walked past as I was reaching out the window to rescue my girlfriend's cat. It was really late and I didn't bother putting anything on. My gf and I laughed like hell about it. Her mom couldn't look me in the eye after looking me in the brown eye.

  • ||

    Oh god, that's amazing. This friend (who is my college roommate's ex, so we've all seen each other naked more times than I can count) demanded to see the picture and criticized my composition; she offered to help for future shots.

    Her whole family is absurdly laid back though, at her wedding her mom surprised her by hiring a belly dancer.

  • itsnotmeitsyou||

    It's kinda hard to take a picture of your own ass, no?

    I've taken pictures of my junk before and that is hard to get a good picture.

    Oh, and how much composition does the pic need. There's cheeks, brown eye, and maybe some junk involved.

  • ||

    Timer shooting, and preferably a mini-tripod.

    I've been doing some hobby photography (not sex related) and had better ideas for composition and whatnot and my current pic is significantly more...compelling, than previous ones.

  • db||

    Just like how social services get judged not by the outcomes of the patients or clients, but by how many "units of treatment" were delivered.

    It's like a surgeon saying, "the operation was a complete success! I made 140 incisions and transfused 600 pints of blood into the patient, so we really did deliver a lot of treatment in this case."

  • itsnotmeitsyou||

    I really wish my IT department's "success" was graded like that.

    Well, boss, I spent $300,000 this last year, so I must be doing great!

    What did you spend it on?

    IT stuff... obviously. Now stop asking so many silly questions. You need to write an even bigger check for this next year. I'm going to do 50% better!

  • sarcasmic||

    What other metric do they have?

    It's not like they've got profits or price signals to tell them what kind of a job they're doing.

    The purse holding bureaucrat in charge of paying for the project I work on does his best to prevent work from being done. Even though there's a team of developers sitting around itching for something to do (you don't think I'm posting here because I'm busy, do you?), he views his job as holding back as much work as possible because work costs money.

    It is utterly moronic.

    Oh how I long for the days before a committee was put in charge of the workload.

  • Brett L||

    Eh. I've had a single asshole stop all work because he was unsupervised. No, I mean literally his boss (the CTO) left and he decided he wasn't doing shit until there was a new CTO. Not continuing ongoing projects, not maintenance of existing and irreplaceable systems, not his own pet projects. Not a fucking thing.

  • itsnotmeitsyou||

    Was that place union or did nobody think to fire his ass?

  • Paul.||

    He may be doing it as a defense mechanism. There may be a backstory here.

    Nothing makes a self-starter more skittish than punishing your self-starters.

  • itsnotmeitsyou||

    I suppose that's possible, but from the information Brett gave, it sounds like the guy was just a lazy ass.

    I could understand if he didn't start any new projects until he had direction from a CTO, but not doing maintenance on existing systems? Not even doing his own pet projects? Sounds to me more like a "cat is away, the mouse will play" scenario.

  • sarcasmic||

    I'm in the exact opposite situation. I am not allowed to do any work, not even fix obviously broken code, unless I am given explicit instructions to do so.
    We were finally given some assigned work, but told that we can't actually do any of it yet. First we must perform complete analysis. Things as innocuous as fixing misspelled words need complete analysis. It's like I work for a bunch of retards or something.

  • itsnotmeitsyou||

    Do you work for the government by chance?

  • sarcasmic||

    Contractor. It was fun when I started because we were able to respond to the customer and get stuff done. Then they put a committee in charge because we were doing too much work. They had to slow us down. Fucking sucks. I've been looking for another job, but as everyone knows the job market sucks. Lots of sucking, except in the bedroom. At least the bills are paid.

  • Brett L||

    Do you work for the government by chance?

    Winner! Well, I did in that job.

  • Paul.||

    It's like I work for a bunch of retards or something.

    Actually, you work for a place that assumes a bunch of retards work for it.

    That's a clear sign that your leadership doesn't trust its employees. Leave.

    (Like I'm one to talk).

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