Monday, March 27, 2006


RHIOs in a free enterprise market:  How to fund EMRs and RHIOs in the 21st Century.

     Healthcare reimbursement in the past 25 years has undergone a sea-change. Our system based upon free enterprise is now actually a mixed oligopoly, consisting of entrepreneurial businesses, as to cosmetic and/or elective procedures, private payors as well as public funding by medicare and medi-caid.  A system of reimbursement documentation has evolved based upon CPT codes and ICD codes justifying charges for
each claim. In addition to the “billing side”, there is the payment side with EOBs and other documentation of payments.

     Hundreds of individual RHIOs are in the planning and evolving stage of implementation.  Some are initiated with public grants and/or funding.

      A new model for integrating the cost of digitizing health information, and it’s
Cost for transferring the data is necessary, and should be based upon the “value” inherent in the data and it’s transmission. Pay for performance and outcome studies have gradually been added to the mix of required documentation. This raises several important questions.

     What is the inherent value of this information?  Will it lead to better outcomes, save unnecessary costs, and how do we account for the expense of initiating and maintaining this “tracking system”?

     Should the value be a flat value per transmission or based upon the number of
bytes in the communication. (ie, like text messaging on the cell phone network)
     Should the value be on a scale based upon the RVS fee with an assigned RVU? Perhaps it is time to update the RVU and allot a portion to the   EMR and RHIO overhead. These calculations done by Hsiao in the late 1980s are obsolete and dated.

     What is it worth to the payor to have data transmitted to them electronically vs paper?  Should the cost saving be passed along to provider, patient, or should the payor
Participate in the overhead of the system?

     When requesting patient health records, what is it worth to the requesting provider
And/or patient to have the data transmitted electronically?  One can calculate the expense of dictation, transcription and mailing of such information between providers and providers and payors.

     We do need some form of accountability for EMRs and RHIOs.  It is time to upgrade the RVS to take into account the  advances in technology.  This has been a glaring deficiency in the RVS system which has not been updated for over a decade or more.  

     We know that the technology is available to meet the demands of EMR and RHIOs.  We need the payors, government and regulatory agencies to come together
To create the financial revenue stream to pay for it.  My ideas are workable within our
Present system.  Jon Porter, R of Nevada proposes congress set up a “trust fund” to accomplish this…..we already have the trust fund…it is called medicare….the remaining
Private payor system needs to be constructed as well…they could contribute to the trust fund with mandatory payments.


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