How My Cousin, President George W. Bush, Almost Killed Athenahealth - InformationWeek
Healthcare // Policy & Regulation
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How My Cousin, President George W. Bush, Almost Killed Athenahealth

In this excerpt from his book "Where Does It Hurt? An Entrepreneur's Guide to Fixing Health Care," Athenahealth CEO Jonathan Bush addresses the conflict between government and disruptive innovation in healthcare.

Athenahealth started as a chain of birthing clinics struggling to get insurance claims paid. This story, excerpted from "Where Does It Hurt? An Entrepreneur's Guide to Fixing Health Care," follows the company's pivot to cloud software and business services.

By the time summer 2004 rolled around, it had been five years since we exited the San Diego birthing business. We stopped hiring midwives and started recruiting software engineers. We were an Internet business, and those investors who used to run away screaming at the very mention of my name promptly rushed back with fists full of dollars. The dotcom bust came a year later. But it was barely a speed bump for the new athenahealth. That same year my cousin George was elected president. He was a funny, charismatic figure from my youth, but I hadn't seen much of him since.

I was now the CEO of a rising medical data company. We built automated systems to handle the administrative chores for thousands of medical practices. They didn't buy anything from us. Instead, they subscribed to a service on the Internet. This was what would later be called a cloud-based service, but in these early days of Internet era, we were still searching for a name for it. My partner Todd [Park] used to say in speeches that he would give Polynesian fruit baskets for life to anyone who came up with a single name for the combination of software, knowledge and work that we were selling. We had moved back east and had a new headquarters in a historic brick armory building along the Charles River near Boston. Our future looked fabulous, except for one problem: My cousin, the 43rd president of the United States, was about to sign a bill that could destroy us.

This bill, like so many government initiatives, stemmed from the best of intentions. The idea was to encourage the migration of the health care industry from cumbersome binders full of paper to electronic records. How was this to be accomplished? Well, hospitals and doctors were forbidden by so-called anti-kickback laws from exchanging services, information or products of value with each other. The bill before Congress in 2004 offered a regulatory safe harbor for hospitals to provide doctors with all the digital technology the bureaucrats could think of: servers, software licenses, and training. That was absolutely the right answer ... for 1982. The long and short was that hospitals could buy all the old stuff from our competitors, but none of the new still-to-be-named services from us. As often happens, the technology was advancing much faster than the law.

I caught the shuttle down to Washington and commenced lobbying with the fervor of a man with a gun to his head. I raced up and down the marble halls of Congress, looking for someone, anyone, who would take the time to learn why this bill was so very wrong, so backward, so devastating, so lethal -- at least to athenahealth.

But let me tell you, if you walk into Congressional offices sputtering about a clause in a bill that practically no one has read, something that has to do with hardware and software and online services, people tend to hurry away, or point you toward the door. I could find no one to pay attention. And as I grew more frantic, I started talking louder and faster. That didn't help things.

Some might find my frustration strange, considering that during this drama my cousin was sitting a mile away, in the Oval Office. Wouldn't a Bush, facing legislative trouble in Washington, contact someone in the White House entourage? The answer is no. Placing a call to him was not even a remote possibility. For starters, it's unethical. It is also politically foolish. It would place him, me, and my company in scandal and bring shame upon our family. I would be much more willing to climb the steeple of the tallest church and bungee jump naked in the middle of the night than to call my cousin. And even if I were dumb enough to make the call, I trust George would have the good sense to tell me to get lost.

At the time of this drama, my fast-growing company employed hundreds of people in Massachusetts. But I could not get anyone on the state delegation to hear my plea. (It's conceivable that my family name was working against me.) Finally, I located a congresswoman who would listen to me. It was Nancy Johnson, a Republican who had been representing her Connecticut district since 1983. She chaired the health subcommittee of the powerful House Committee on Ways and Means.

I walked into her office and saw the 69-year-old congresswoman sitting behind a desk. She was paging through an enormous sheaf of papers. That was the bill. Embedded in that piece of legislation were hundreds, if not thousands, of amendments, earmarks, and wrinkles added by one interested party or another, along with thousands of other details that just landed there by dumb luck. Other items, like the all-important clause "and Internet services," were simply missing. It struck me as I watched her paging through this bill that my drama was only one of thousands, or even millions, that would result from this mountain of legislation. A single detail can throw lives, or entire companies, into a tailspin. It can reroute billions of dollars, turning winners into losers, and vice versa. Government is like the giant with an Uzi. It means so well, but if it gets scared or sad or confused, it can squeeze off 80 rounds without even noticing the bodies falling around it. One single law can put technologies that should have disappeared a generation ago onto eternal life support and close the door on their superior replacements. Now, in the last day or two before the bill became law, Rep. Johnson was committed to 

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Jonathan Bush is Chief Executive Officer, President, and Chairman of the Board of Directors of athenahealth Inc. He co-founded the Company in 1997 and took it public in 2007 in the most successful initial public offering that year. Today, athenahealth remains one of the ... View Full Bio

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User Rank: Author
5/15/2014 | 12:27:17 PM
Re: Is this how health IT regulation works (or doesn't)?
Yes, it's self-serving. He wouldn't have written a book that doesn't serve his company's interests. But he nonetheless raises some excellent points. The key here is his thesis (and it's not an original thesis) that healthcare costs will continue to race ahead of inflation unless insured consumers have a financial incentive to shop for lower-cost care. 
David F. Carr
David F. Carr,
User Rank: Author
5/15/2014 | 11:57:09 AM
Is this how health IT regulation works (or doesn't)?
What do you think of Jonathan Bush's analysis of the structure of health IT regulation? Accurate or self serving? Partisan or practical?
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