Trend Lines: Show Me the Money

By Barry P. Chaiken, MD, MPH

As the country wonders about the next iteration or obliteration of the Affordable Care Act and how to prepare for changes to the healthcare marketplace in 2017, the 1996 movie Jerry Maguire, starring Tom Cruise and Cuba Gooding Jr., may have all the answers we need. Cruise plays Maguire, a sports agent who represents Rod Tidwell, a fictional Arizona Cardinals wide receiver played by Gooding.

In one poignant scene, Rod chastises Jerry in an effort to motivate him to secure a higher-value contract for Rod’s services to the Cardinals. Through the repetitive mantra “show me the money, Jerry,” Rod makes it clear to his agent that only the money value of the contract matters (“Jerry Maguire,” 2016).

Wise observers of healthcare trends understand that the industry’s direction always relates to the flow of money. Provider organizations, clinicians, life science companies, and healthcare information technology vendors all take positions that closely follow the economic incentives presented by the marketplace. So, to understand the fate of the Affordable Care Act and the focus of the industry in 2017, just ask the various stakeholders to “show you the money.”

Affordable Care Act

At the close of 2017, some version of “x-care” will exist. Whether it be Obamacare, Trumpcare, or Ryancare, no one’s mantra will be “I don’t care.” There is just too much money at stake.

The current muted response to the threat of the Affordable Care Act’s repeal is mostly due to the various interests figuring out how to position themselves to benefit from changes to the current law. In time, the battle lines will be drawn, and as we hear statements focused on patient access, quality of care, and clinician autonomy, the underlying theme will be the fight to enhance the economic position of the interested party. Similarly, our politicians will be motivated by their reelection prospects, making it unlikely that the 20 million people newly enrolled under the Affordable Care Act will be forced to lose coverage through its indiscriminate repeal.

Value from EMRs

After spending more than $30 billion on incentive payments, many in and out of government wonder what value the investment in electronic medical records (EMR) has delivered to patients. Similarly, many hospital boards of directors, provider organization leadership groups, and physicians in private practice wonder about their return on investment from implementing healthcare information technology (HIT) systems.

EMRs are expensive to implement and maintain, and there is no clear evidence that they increase productivity, enhance quality, or reduce medical errors. Although studies do show some benefits obtained from the use of EMRs, this evidence is not definitive, and any positives from their use are not widely reported across the industry.