CIOs and CMIOs Speak Their Minds about the Supreme Court Decision

This week, some voices of healthcare CIOs and CMIOs, speaking out about last week’s U.S. Supreme Court decision on the Patient Protection and Affordable Care Act:

Marc Probst, Chief Information Officer, Intermountain Healthcare, Salt Lake City, Utah

Bottom line is politically I don't like the ACA and the lack of financial responsibility which our country’s leaders have. In the end, the problem of "going broke" just continues to escalate. 

Craig Joseph, Chief Medical Information Officer, Agnesian HealthCare, Fond Du Lac, Wisc.
Clearly, HITECH (and the Meaningful Use money that accompanies it) was not endangered by the SCOTUS decision. If the ACA were overturned, there was reasonable concern about CMS' Shared Savings program, value-based purchasing, and various quality improvement methodologies. That said, I think many CMIOs are confident that the train has left the station with regard to healthcare information technology. The future practice of medicine will require physicians (and the hospitals in which they practice) to prove they are providing quality, evidence-based care. This is impossible to do without HIT. So even without ACOs and the CMS programs, HIT will remain an inherently necessary ingredient for population management, evidence-based medicine, and quality healthcare.

Michael Zaroukian, MD, Vice President and Chief Medical Information Officer, Sparrow Health System, Lansing, Mich.
Having said that, I think the most important thing is the fact that the vast majority of the Affordable Care Act was considered constitutional and remains intact, which allows us to continue on the path that most of us in healthcare and in healthcare IT have been using as our guide to try to help with the process of redesigning systems to support the expected increased number of care recipients we'd be able to provide care for, the nature of the practices and the workflows necessary to support that care, and to be able to predict a little bit better the resources necessary to be able to support care for those patients in our organizations.

So I think the biggest part of this is to create some sense of certainty about the kinds of patients we'd be seeing, the kinds of care we could be expected to deliver, and the ability to expand our services to populations that need care (and who have perhaps for example been underserved with regard to preventive services), to care for chronic conditions, and to be able to know that there are resources beyond what have been considered before, such as lifetime limits on coverage for some of those chronic conditions, or the ability to provide care for preexisting conditions.

Michael Zaroukian, MD, Vice President and Chief Medical Information Officer, Sparrow Health System, Lansing, Mich.

On the impact of the decision on Sparrow Health's priorities: I'm not sure it changes our priorities much. We saw the HITECH Act as giving a pretty clear roadmap for us to follow in the health IT world. I think the biggest issue is knowing that there will be more patients in the system, and an even greater reason to have health information exchanges, since those patients will receive care in various settings, and basically in some ways just some excitement about the ability to make sure more patients get the care they need and don't have to make the difficult decision about waiting to get care until their care needs are more extreme than they would otherwise be.

On the ruling that states could opt out of Medicaid without a penalty: I'm empathic with the judgment that says on the one hand it's expected that states will indeed participate in one form or another of this. It is an underserved population. I think the court's view of it being a bit too aggressive or assertive to say that if you fail to fully participate in this, then you lose all of your funding, I actually resonate with that. I think many of us would. I think it's a little bit hard to say exactly what does it take for a state Medicaid program to feel whole in this process. So I think it probably is the better approach to say, given the alternative of either saying you have a choice or you lose all of your funding, it's better to allow states to have the choice. I think most states want to do the right thing with regard to covering their patients, and that they'll find their way to that process a little bit better if they aren't held against sort of an all-or-nothing participation approach.

On the possibility that the public may opt to pay extra taxes rather than purchase healthcare: I think it's a little hard to predict indeed early on, because some people will make their early decisions philosophically, but since none of this really takes place until 2014 in that regard, I think most people will make decisions based on common sense, their economic interests, their perspective with regard to the likelihood that they'll need care, and with some experience that we accumulate in the time between now and then that shows indeed what are the likelihoods. I think most people want to have the safety net that insurance provides. I think when they consider the cost of a penalty, if you will, for not doing so, versus the cost of it, they'll make the decision most of us end up making. In Michigan, there's a requirement to have auto insurance. So it's not that foreign from that perspective. That of course is a state as opposed to a federal type of mandate, but I think in the end most people will make an economic decision and talk about it within their families and decide how best to spend their money.