State variation cornerstone of reform says HCFA's Vladeck. _

Healthcare Financial Management, Jan, 1994 by Wendy Herr

Herr: What about electronic processing of clinical information?

Vladeck: We continue to face the problem that the amount of information that is generated by clinicians at the point of clinical care is far in excess of what even the most modern technologies can realistically store, retrieve, and transmit. Ultimately, there are three possible solutions to the problem. One is to get very clever in our ability to manipulate and to use very limited data sets. The second is to continue working with all the data long enough to find out what the real tracers or key variables are that have not yet been identified, then define the data sets and use them. The third solution is to apply brute force. As technology continues to develop and reduce the cost of data storage, retrieval, and transmission, it may become economical to store and manipulate these massive quantities of data electronically.

Herr: In conclusion, is there anything in particular on the HCFA agenda that healthcare financial managers should bear in mind?

Vladeck: The next major headache we are going to create for healthcare financial managers will occur as we begin to disentangle the mess of hospital outpatient payment policies and the like. There has been a fair amount of sentiment within both the executive and legislative branches of the government over the last three or four years, as people began getting a sense of how big a project it is, that if they close their eyes and hold their breaths they will not have to deal with it. But they are wrong--it must be dealth with.

First, we must address the continued and very rapid growth in costs. Second, we must address the fact that we are now being sued by the beneficiaries because beneficiaries, on average, are paying 50 percent coinsurance for any outpatient surgery and radiology. In our view, this is consistent with how the statute reads, but probably not what Congress intended and probably not good public policy. We also continue to have this hodge-podge of unrelated payment methods for different kinds of outpatient services and a whole set of issues relating to inequities between hospital-based providers and freestanding providers. Nobody really wants to deal with the situation because it is such a mess and it is so complicated and there is only so much money. But the longer we put off dealing with it, the worse it gets. The problem has reached a magnitude of such significance that we have to address it.