- Transformation: To transform care you need to transform the culture - large enterprises have such skills and resources, but for many other smaller providers, such methods are not as abundant.
- Innovation: Again large enterprises have the resouces to deploy disruptive innovations like EHRs, while smaller or less sophisticated providers do not have the experience and resources required for transformation and innovation.
- Meaningful Use Politics: The debate is polar - those who think you can push reform through by regulation verses those who believe that market pressures will create the best response to health reform initiatives and a more honest reality.
Entities large and small have a very full plate - HIPAA, ICD-10, Meaningful Use, HIE, EHR/EMR, ACO...financial viability...are but a few pressing needs. Add to this that Medicaid enrollment will increase under reform and with per capita growth in the number of physicians being relatively flat for the past decade, 40% of U.S. primary care physicians currently considering leaving their field and those remaining increasingly not choosing to treat new Medicaid patients, how will some reform efforts not blowup? Increasingly, the literature is showing good results and that meeting increasing patient volume and needs is being met by reformulated care teams that incorporate greater participation by Home Health, companion services, remote care technology, the patient and caregivers in the ACO/Medical Home model.
As leadership changes at the ONC, it's time for them to consider how to help providers complete all of this by picking the low hanging fruit in a time of growing fiscal restraint and not try to transform too much merely by regulation.