ALBUQUERQUE, N.M. — The state of New Mexico operates three main lines of business: education, health care and public safety. They account for 80 percent of state expenditures. Spending on everything else is trivial compared with these functions.
Budget analysts have determined that worse-than-expected revenue collection, in particular collection from the state’s slumping oil and gas industry, could mean that the state’s spending in the 2016 and 2017 fiscal years could exceed revenue by $600 million. Our Constitution doesn’t allow deficit spending, so lawmakers are expecting to be called into a special session to balance the budget, which usually means at least some consideration of across-the-board spending cuts.
Instead of taking a hatchet to the state’s Medicaid expenditure (close to $1 billion and growing fast), there could be a way to take a significant bite out of health care spending simply by getting all health care providers and payers from around the state to share information about their patients with one another, according to the New Mexico Health Information Collaborative. NMHIC estimates that health care spending in New Mexico could be cut about $35 million a year through information sharing. Because about half of all New Mexicans are Medicaid beneficiaries, one could infer that effective information use could cut Medicaid spending by $17 million or so.
But when it comes to health care, nothing is ever simple or straightforward. There are a number of barriers in the way of reaching those savings.
To get a sense of how information translates into medical cost savings, let’s revisit a story I reported in 2013.
Bob White is an urgent care physician with ABQ Health Partners. One weekend, an elderly man showed up at urgent care with symptoms of a stroke or heart attack. Instead of doing an expensive and time-consuming work-up, White was able to look at the patient’s medical records in the NMHIC system and found that the Presbyterian Healthcare Services system had performed an extensive round of testing not long before. Several tests that White would have administered if he hadn’t had access to those records were unnecessary. Before NMHIC, the best White could have done was attempt to reach the patient’s medical team at Presbyterian by phone.
Health systems and practices have for some time been installing information systems allowing them to store patient health records electronically. Several vendors developed electronic health records, or EHR, systems that could not communicate with one another. Major New Mexico health systems adopted different and incompatible systems. NMHIC established standards for information exchange and installed a software system that lets a record uploaded by a system using software from one vendor to be accessed by a system that uses another vendor’s product.
NMHIC says that 27 New Mexico hospitals with 2,426 beds upload their patients’ medical data to the collaborative’s computers in Albuquerque. There are 2,100 medical providers sending patient information to NMHIC. Among them are Lovelace Health System, Presbyterian, the University of New Mexico, ABQ Health Partners, Holy Cross Hospital in Taos and Christus St. Vincent in Santa Fe. If every hospital and provider contributed data, NMHIC would have patient records from 47 hospitals with a total of 4,630 beds and from 4,050 providers. Among the benefits of getting every hospital and provider into the collaborative, according to NMHIC:
⋄ Duplicated testing, imaging and consultations would be reduced, for a saving of $14.7 million.
⋄ Improved care through information sharing would reduce readmissions to hospitals, lower the amount of time patients stay in hospitals and simplify hospital care. That could save $10.2 million.
⋄ Medical record collection, management and distribution costs would be avoided to the tune of $7.8 million.
⋄ Avoidable adverse drug reactions could save $2 million.
It sounds good, but to repeat, nothing is ever simple or straightforward when it comes to health care.
Equipping all of the remaining systems to work with NMHIC would require a $4 million investment. Federal money is available to pay 90 percent of that bill, but each practice and hospital has to get the money and the software.
Despite efforts to standardize information, different systems allow users to enter data that could be unrecognizable by another system. NMHIC officials joke that you could get 100 records uploaded to the collaborative, each with a different spelling of the word “aspirin.”
There are still some practices and hospitals that won’t use NMHIC because they worry that confidential patient information would get into the wrong hands or that a competitor might be able to use patient information to gain some sort of advantage.
Some say that, after a decade of work, NMHIC got to market too late. The EHR vendors have recognized the Tower of Babel problem they created and are installing modules that allow exchange of information among systems. NMHIC argues that its approach of providing a centralized and safe archive of records available to all systems will make more information and more useful information available to anyone when and where it is needed.
UpFront is a daily front-page news and opinion column. Comment directly to Winthrop Quigley at 823-3896 or firstname.lastname@example.org. Go to www.ABQjournal.com/letters/new to submit a letter to the editor.