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taken before.” To do that you have to coordinate care and
Care Transitions is the beginning of that.
But Care Transitions and readmissions is an outcome. It is
a very specific item we can count. Its not hard to do it, but
it is an outcome of care. Its not just per anything. If you can
keep your pneumonia patients healthier and keep them out
of the hospital then you are going to do well under bundled
payment. And we will have taken one step towards that
goal. Another one they are taking is in the way we pay
physicians. Right now, in the way that physicians are being
reimbursed to use EHRs, youll get your first incentive pay-
ment for just going to get an EHR system and setting it up.
Theres another step up increase where youll get another
participation because you are actually using it for e-pre-
scribing and things like that. The highest level of participa-
tion is called meaningful use. Meaningful use is actually
going to be where that physician is showing hes using his
EHR information to make sure the care for that patient is
coordinated in some fashion. We dont know how that final
payment is going to work out. There are a lot of ends to tie
up on how that will actually be done. But all of those type
things, even if they are just process measures, will prove
the physician is counting the number of HbA1c tests youve
had, hes actually maintaining a file for you on lipid profiles,
diabetic eye exams, prevention, immunizations, well-per-
son checks. So we will be moving from paying a physician
from simply another click because a patient walked through
to an outcome. Not totally, but part of his reimbursement
will be tied to those outcome steps.
Its a logical thing to do. Its very reasonable. Its possible
for us to do it and Im quite certain that we are going to do
it. Its a matter of how soon can we get there? But the prob-
lem is really extremely urgent. A lot of people dont agree,
but I remember when people were complaining when
healthcare costs were about 13% of the GDP. Now its up
around 17% to 19% and its going to go to 25% percent
before we can ever do anything about it because EHR
adoption is not going to be a reality in three years and
meaningful use is going to lag probably another three years
behind that. Truth be known, we are going to go through
the next ten years without the infrastructure that we really
need to coordinate care. From this point there is nothing we
can do about it. But if we do everything we need to right
now, in ten years we can have a handle on coordinating
care for patients across settings and across intervals of
time. If we dont do it and we dont start now, then the price