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You can't get there from here: misplaced incentives can undermine the goals of health care reform in the NICU setting

Journal of Perinatology volume 32, pages 570–573 (2012)Cite this article

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There is an old saying used for circumstances in which the path from a traveler's present location to the final destination is necessarily so circuitous and non-intuitive that making the trip becomes absurd. The start and finish points may, in fact, be very close in distance, but there is no navigable direct path. ‘You can't get there from here’ implies that either the direct route is fraught with insurmountable hazards or the traveler has strayed so far off the correct path that backtracking is unavoidable. The United States is fast approaching this point in achieving some of the Health Information Technology (HIT) goals set forth in the American Reinvestment and Recovery Act (ARRA),1 and the incentives set forth in the act may, indeed, undermine specific goals set forth in the Affordable Care Act (ACA).2 Specifically, the goal of decreasing health disparities is undermined when identifiable patient populations are excluded from incentives programs and real meaningful use standards. This article examines the disparity created by excluding babies <2 years old from the benefits that meaningful use standards and incentives afford other Americans.

Title 1 of the ACA requires establishing ‘quality, affordable health care for all Americans,’ and one of the methods aimed towards reaching that goal is improving outcomes by improving patient safety through HIT. Section 2717 ensures the quality of health care through reporting that is to take place within 2 years of the act's passing and includes implementation of ‘activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence-based medicine, and health information technology…’ These goals are all included in the section entitled Group Market Reforms.2 As a means of accomplishing the goals for HIT set forth in the ACA the ARRA includes provisions establishing an office of the national coordinator for HIT that is charged with protecting privacy and security for electronic medical records (EMRs), improving quality care through reduction of medical errors, reducing cost by improving efficiency and reducing health care disparities, among other things.1 In order to achieve these goals medicaid and medicare are authorized and obliged to manage incentives to providers and health care systems in a ‘carrot and stick’ fashion.3 Hospitalists and affiliated physicians, who work primarily as inpatient providers are excluded from incentives.4 Most neonatologists—who traditionally function as baby advocates in health care—fall into the category that does not qualify for incentives. Generally, the justification for the exclusion of inpatient providers from incentives is that these providers use the EMR that a health system is already receiving incentives to develop, but the case for neonatology is unique because most of the meaningful use standards provided are not helpful or appropriate for the neonatal intensive care unit (NICU), and babies <2 years old have been excluded from meaningful use.5, 6 Hospital systems use meaningful use standards and incentives as a means of addressing patient population needs in HIT, and hospitals are currently left without this means for babies.

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  1. Clinical Ethics, Center for Healthy Beginnings, Bon Secours, Virginia Health System, Richmond, VA, USA

    K Stuart

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Stuart, K. You can't get there from here: misplaced incentives can undermine the goals of health care reform in the NICU setting. J Perinatol 32, 570–573 (2012). https://doi.org/10.1038/jp.2012.35

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