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8/14/2013
04:22 PM
Rob Preston
Rob Preston
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Death By A Million Regulations

It is long past time to assess the consequences of the endless laws, codes, rules, licenses and guidelines governing just about every human activity.

Six healthcare industry IT executives recently sat down with InformationWeek editors to discuss a range of issues, from remote patient monitoring to electronic health records to population health management to clinical decision support. But when we started the conversation by asking about "the things that are dominating your agendas," we got an earful on a subject we weren't quite expecting.

"Regulatory. It's just a waste of our time doing ICD-10," said Larry Garber, Reliant Medical Group's medical director for informatics, referring to the new, more detailed set of codes the feds require to report medical diagnoses and procedures. Garber noted that complying with some federal regulations, such as "meaningful use" of electronic health records, is worth the effort. But complying with ICD-10 amounts to busy work. "So unrewarding," Garber said.

Before he could say another discouraging word, Beth Israel Deaconess Medical Center CIO John Halamka chimed in: "So much of my innovation has almost ground to a halt because so much of my staff is dealing with the must-dos from state and federal regulators, much of which is nonsensical and not value-added."

Halamka cited BIDMC's $5.3 million settlement on July 29 with the Department of Health and Human Services' Office of Inspector General (OIG), addressing government allegations that the Harvard teaching hospital had overcharged Medicare by admitting patients between 2004 and 2008 who should have been treated less expensively as outpatients. The Boston Globe reported that BIDMC didn't admit wrongdoing as part of the settlement, "which both sides described as a way to avoid costly legal action."

"It's basically about how you describe an inpatient versus an outpatient observation stay," Halamka told us. He described the issue as "so deeply technical" that it took his IT staff six months to implement the logic needed to comply with the complex regulations. "It's utterly esoteric. But the OIG has decided that it's a priority. This is what we're dealing with every day."

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Forrester Research estimates that companies spend about 1.75% of their IT budgets on risk and compliance management software. But spending estimates go much higher, to as much as 10% of IT budgets, when factoring in security, storage, archiving, content management, e-discovery, disaster recovery and other compliance-related investments. Halamka and Garber suggest it's eating up far more of their organizations' time and creative energy. And when InformationWeek recently asked healthcare IT pros in a survey to rank their top priorities, an astounding 61% put "meet regulatory requirements" as a "top priority" -- 5 on a 5-point scale. Just 47% of respondents ranked "improve care" that highly.

These aren't rabid capitalists just looking to make a quick buck. In the case of Halamka and Garber, they're world-class technologists and highly respected doctors -- Dr. Halamka is a practicing emergency physician and Dr. Garber is an internist. They say they can't find enough time to do what they were hired to do (innovate) and what their colleagues and patient-customers depend on them to do (elevate the level of care) because they and their people are spending much of their 12-hour days dotting i's and crossing t's.

The Best Intentions

Almost all proposed rules and regulations sound reasonable, even virtuous. They're crammed with the best intentions. A patients' bill of rights here. A privacy-protection law or two there.

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RobPreston
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RobPreston,
User Rank: Author
8/15/2013 | 2:50:55 PM
re: Death By A Million Regulations
Got a regulation or two you'd like to see killed? We'd like to hear about it here.
Shane M. O'Neill
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Shane M. O'Neill,
User Rank: Author
8/15/2013 | 5:33:07 PM
re: Death By A Million Regulations
Mortgage regulations are horrible. I could not refinance for the rate I wanted and QUALIFIED FOR because of a Fannie Mae/Freddie Mac regulation that does not apply to my condo building at all yet has to be enforced. It was a year ago and I'm still angry.
mjensen810
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mjensen810,
User Rank: Apprentice
8/15/2013 | 5:59:23 PM
re: Death By A Million Regulations
And if you think it is bad in the medical profession, try banking!
MyW0r1d
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MyW0r1d,
User Rank: Strategist
8/15/2013 | 6:54:19 PM
re: Death By A Million Regulations
It is difficult to defend senseless government involvement and often contradictory regulations, however, ...
As long as there is a never ending stream of Dr. Fata's (allegedly prescribed chemo to patients without cancer) or Conrad Murray's or Bernie Madoff's or Lehman Brothers or the JP Morgan $2 billion loss on "egregious mistakes" as described by Bloomberg Press, just to name a few, I feel little pity for regulation and oversight. These industries have only theirselves to thank for the situation.
mjensen810
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mjensen810,
User Rank: Apprentice
8/15/2013 | 7:06:56 PM
re: Death By A Million Regulations
Thank Dodd-Frank and the Consumer Finance Protection Bureau. It is protecting consumers by making it nearly impossible for them to get a mortgage!
Shane M. O'Neill
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Shane M. O'Neill,
User Rank: Author
8/15/2013 | 7:15:13 PM
re: Death By A Million Regulations
I understand we needed rigid oversight after the subprime meltdown. But these regulations are so inflexible. I was eventually able to refinance with a local bank that keeps the loan in-house (hence can bypass Fannie-Freddie rules). But I didn't get close to the rate of a traditional loan.
rjones2818
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rjones2818,
User Rank: Strategist
8/15/2013 | 7:48:29 PM
re: Death By A Million Regulations
And who gets to decide if a regulation is out of date, etc.?
mjensen810
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mjensen810,
User Rank: Apprentice
8/15/2013 | 8:05:54 PM
re: Death By A Million Regulations
Unfortunately, the innocent get pilloried along with the guilty. As a small country bank, we certainly did nothing to contribute to the melt down or any of that, yet we get to adhere to the same regulations as the big boys.
RobPreston
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RobPreston,
User Rank: Author
8/15/2013 | 8:12:45 PM
re: Death By A Million Regulations
Ah, excellent question. A committee of the good and great? I was half joking.
Thomas Claburn
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Thomas Claburn,
User Rank: Author
8/15/2013 | 8:17:09 PM
re: Death By A Million Regulations
The entire tax code needs to be revised. Ideally, it should fit into 140 characters. Here's 33: All income shall be taxed at 15%.
Page 1 / 3   >   >>
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