Separate Checks

Gary Baldwin, for HealthLeaders Media, March 18, 2008
If I had to boil down my healthcare technology worldview into one sentence, it would be this: "The technology shows great merit, but financial and other political issues remain." Time and time again, we see examples of how technological innovation is hindered by the financial question of who should pay for it. The industry has done a great job of promoting the development of high-end imaging equipment. But that's in part due to the fact the payers are willing to ante up for the procedures.

IT is a different story, however, and the jury is still out on who should rightfully bear the burden of implementing the technology everyone says the industry so desperately needs. With physicians, this issue surfaces frequently. They say, rightfully, that everyone else (read: payers, employers, pharmacies, even patients) stands to benefit if physicians automate clinical documentation. So why shouldn't others pay for it?

The question has become even more muddied, given the recent revelation from Blue Cross of Massachusetts that the financial return of an EMR system for a physician practice is dubious. Hoping to spur IT adoption, Blue Cross had chipped in $50 million to help spark a statewide data exchange. Now it is saying it won't require physicians to have an EMR to participate in its bonus program. Physician order entry systems, for hospitals, on the other hand, will be required down the line.

The economic conundrum came up at a telemedicine seminar I attended at last fall's conference of the American Medical Informatics Association. The presenters discussed how various telemedicine applications that connected patients and clinicians--sometimes across large geographic regions--worked, and worked well. For example, a program in Oklahoma improved outcomes and avoided hospitalization costs for wound care patients. Based on videoconferencing, the system brought together physicians, nurses, and educators. Another project in Rochester, NY, enabled children at remote locations to get pediatric consults without leaving school. That's a winner for the kids and their parents, who may avoid ER trips or skipping work to cart Susie to the doc.

Both projects were sparked by federal grants. But as the grant money runs out, their future remains unclear. To create an economically sustainable business model, the technology would need to be supported by payers in the same way that imaging is. And even if it were, other questions would arise about how the pie should best be split among the participating clinicians. Collaboration across formerly competing organizations is great, but people still need to get paid.

"Who pays?" is a simple question. However, it can elicit a remarkably complicated response, or none at all.

Editor's note: Don't forget to submit your entries for the 2008 HealthLeaders Media Top Leadership Teams Conference and Awards. Deadline for entries is March 27.

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at
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