I’m not in the business of predicting the Supreme Court. But a lot of people who are believe that the court will strike down all or some of President Obama’s healthcare reform law, also known as Obamacare, this summer. The uncertainty of healthcare reform, of course, has a direct bearing on what CIOs will do in the near future.
The changes we’ve talked most about here at E2 -- EMRs and meaningful use -- aren’t really under threat. The funding for those comes from another law called HITECH. What is at stake, among other things, is ICD-10, a new billing and coding system (cleverly named, as it is supplanting ICD-9). It is supposed to go into effect in late 2013, but it was likely to be delayed even before the Supreme Court put Obamacare in doubt.
ICD-10 is intended to increase the accuracy of electronic billing. According to this article, it will expand the number of medical diagnosis codes from 14,000 to 67,000. The main goals were to eliminate billing fraud and improve reporting, but there was also a general belief that drilling down to specific procedures (whose codes will go from 13,000 to 85,000) might help lower costs, because certain procedures could be renegotiated or even eliminated when seen in more detail. At the very least, it was hoped ICD-10 would improve reimbursement systems.
All indications are that at least some justices are prepared to strike down the entire law, which would effectively end ICD-10 unless Congress put it in a separate bill -- an unlikely occurrence with the current Congress. Justice Antonin Scalia practically admitted he was ready to strike down the entire law without really caring what was in it. “You really want us to go through these 2,700 pages? And do you really expect the court to do that?” When challenged that at least it would be easy for his clerks, Scalia said, “I don't care whether it's easy for my clerks. I care whether it's easy for me.”
Apart from my personal outrage (and perhaps naivete) that the Supreme Court could strike down 2,700 pages of law without actually reading them, it is a clear indication that at least some of the court is ready to attack the entire law, not just the individual mandate.
With that in mind, what’s a CIO to do? This Information Week article suggests that institutions that have already started traveling down the path of IT changes will likely continue. The value of EMRs, health information exchanges, and even new payment structures like pay for outcomes or value-based pricing (both requiring EHRs to be effective) are too high to abandon.
But the slower the start you got, the more likely it is you won’t bother finishing the job. It is only human nature. And with government mandates and subsidies potentially disappearing, the impetus will be gone.
Still, unless you’re truly strapped for the budget, the smart CIO should probably try to keep going. Meaningful use and EMRs are still being subsidized. In many ways, they’re the “front end” of other initiatives like health information exchanges and ICD-10. Once you’ve paid to put those in place, your hardest work is over. Take the chance to transform your organization. It will be worth it to your patients and to your bottom line. Also, if you keep pushing away, you won’t be one of those people who wasted three months only to find out that you bet on the wrong reading of the tea leaves.