Skilled nursing providers were given the short shrift when legislators wrote and enacted health information technology (HIT) meaningful use legislation. Acute care hospitals and docs were given federal dollars for tech innovation, but LTPAC providers were given nothing helpful (money, guidance). SNF providers were given mandates related to improving quality, but not the means to measure and improve it. Legislators and regulators demand more and more from skilled nursing providers related to quality outcomes, but they ignore that the data needed to drive better outcomes has to come from somewhere.
When our Director of Risk Management Angie Szumlinski and I were down at the American Health Care Association (AHCA) Quality Summit in San Antonio recently, we heard a lot of people talking about the information infrastructure required to drive better outcomes. Reducing antipsychotics, improving customer satisfaction, and implementing QAPI all require robust data systems and processes.
Improving the lives of our frail and elderly requires technology. It’s important stuff. That’s why I’m really excited about my appointment to the American Health are Association Health Information Technology (HIT) Committee.
This January I was appointed to the AHCA Health IT committee. The committee’s objective is to “develop a comprehensive strategy to address the evolving health IT policy environment as it relates to long term and post-acute care and report back to the board.”
Seems like a big amorphous job, right? That’s fine with me. When it comes to all projects big and amorphous, I follow a simple two-step approach. Step one: find out what’s been done. Step two: discover what the data implies.
Step one: what’s been done? Well, nothing.
Step two: what does the data imply? Actually, there is no data.
Why CMS Is Regulating Health IT without Providing Support
I’ve been told by an insider that the majority of SNF providers didn't want to lobby the Feds for Health IT implementation money or guidance when the issue was first being discussed during the drafting of the ACA. SNF providers didn’t want the Feds rooting around in yet another area of their business.
It seems logical, but in the end it was counterproductive. The Feds insinuated themselves into Health IT implementation anyway, but didn’t have to provide any support. They did this by requiring certain measureable quality outcomes.
Here’s how it works. When CMS promulgates rules - for instance, for the measurement and improvement of adverse events - CMS is in effect regulating Health IT. You have to subscribe to a solution like QA Reader or build one yourself. When CMS requires a reduction in antipsychotics, it’s doing the same. If CMS requires providers to improve a certain measure, it’s also requiring the provider to collect and analyze data. It’s requiring Health IT.
In the end, we have CMS regulating Health IT without providing any support. It’s regulation without resources, which is a good deal for CMS, but not for SNFs.
What Resources Do LTPAC Providers Need?
Now, let’s take a look at our lack of data. We have no data regarding what LTPAC providers want in Health IT. We have no data regarding what systems SNFs and ALFs have implemented. We have zero data on meaningful use. It was required by the Feds, so we didn’t collect any information.
This seems like a logical place to start. Let’s collect some information. Let’s first figure out what LTPAC providers think are the most important issues regarding Health IT. Let’s conduct a nationwide Health IT survey. That’s a good first step to develop a comprehensive strategy to address the evolving health IT policy environment as it relates to long term and post-acute care and report back to the board.
Our thought is to start with the following questions:
- What is the scope of your HIT infrastructure?
- Do you recognize any gaps in your infrastructure? If so, what are they?
- What will the next 2 – 3 years bring regarding your HIT needs?
- What do you see the future being regarding the growing data needs of your referral networks, CMS and other stakeholders?
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