The other Mr. Bush

The other Mr. BushThe Boston Globe published an interview with athenaHealth CEO Jonathan Bush yesterday, becoming the latest news outlet to respond to Athena's recent PR initiative. (See for example the non-scientific survey of payment times, which was treated as big news by the New York Times, among others.)The latest interview is almost totally incoherent. Read it if you don't believe me. That could be due to sloppy editing, but the interviewer, Globe writer Christopher Rowland, usually writes clearly.I would have just ignored the piece, despite its wrongheadedness on the current state of electronic health records (EHR) and government policy. But then I read this exchange:

Q: So what do you think about the Massachusetts eHealth Collaborative [MAeHC] experiment to build full electronic patient records in three communities [North Adams, Newburyport, and Brockton, in a $50 million project funded by Blue Cross and Blue Shield of Massachusetts]?

A: That's way off on the wrong track. If you could just pay for results, rather than pay for inputs, you'll probably do better. Markets work better.

We changed AthenaHealth 100 times. We had certified nurse midwives on salary and I had no browsers.

Now we're a Web-native, dot-communist bunch of MIT guys, analysts, and recovering Fleet Bank people working together to form this integrated clinical, financial, paper, analog, digital process.

I'm not sure what communists and midwives have to do with MAeHC, so I'll skip that part. But let's have a look at the first paragraph, which I'll summarize as follows:

• BCBS should pay for outcomes rather than funding MAeHC
• MAeHC should get out of the way and let markets do the job

Neither one of these statements holds up.

• BCBS and other MA-based health plans have extensive pay for performance (P4P) programs, designed to align payment with outcomes as much as possible. They'd like to expand P4P and make physician quality more transparent to consumers, but because physicians use paper records there's little data to collect and analyze.
• Market forces aren't doing a good job in this area, because health care in the US is very far from a free market. Payers gain most of the financial benefit from EHRs, while in the current environment physicians pay most or all of the costs. And physicians aren't in a good position to manage IT implementation projects such as EHR adoption. In addition, the community as a whole can benefit from health information exchanges and common standards, something that requires a more centralized body to establish.

By bringing in payer financing, MAeHC is aligning benefits and costs more closely and demonstrating the results that can be achieved when whole communities are wired up. Physicians are adopting integrated EHRs and practice management systems (PMS), which include the billing function. The Collaborative is also setting up health information exchanges, which will cut down on all the faxing and paper records that Bush rightly deplores.So why is Bush badmouthing MAeHC?Bush's company, athenaHealth receives a substantial cut of physicians' revenues in exchange for assuming the hassles of billing and collection. In the arcane world of coding and billing, where each payer maintains arbitrary, changing, and unpublished rules, and where clinical practice and billing are disconnected and paper-based, athenaHealth's revenue cycle management approach offers a strong value proposition.I wonder if Bush is worried that MAeHC's promotion --with payer backing-- of integrated EHR and PMS systems such as eClinicalWorks will obviate the need for athena's services and blunt the entry of athena's new athenaClinicals.It wouldn't look good if athena's lunch got eaten right in its own backyard, but it could happen.