David “Stalin” Brailer likes being on the west coast, so is happy to come out here and give talks.

He says it’s obvious. Health care IT needs P4P.  And you can’t recoup the benefits of an EMR unless it’s aligned with the direction that the health care market’s going. So the market has to change. But 1.5% of the revenue (a typical P4P bonus) is not enough, although it might be enough on the margins for a few.

Meanwhile, Brailer’s office is now certifying what is a “valid” certified health record (CCIT) and wants P4P programs to help encourage that. And he like everyone else thinks that P4P requires health care IT.

But as there is no agreement on what we’re measuring, none of this works. The industry (public and private) needs to come together to agree what the hell it is we’re measuring. Brailer thinks that  American Health Information community (AHIC) is doing that.

But we also need to commit to changing the way we pay doctors and help them along. No one knows if it’s IT that helps or management or what.

BUT he notices that health IT works better among bigger practices. His mission is not to drive everyone into big groups. This has to be made bite size for smaller practices. As the tools are much further along for the bigger groups, which tracks with the ability to do pay-for-performance. So we have a big investment to make to bring along everyone. We have to bring along the little guys too.

(I’m hearing more about this from Brailer than I was year ago)

Both health IT and P4P favor standalone rather than integrated care. Normal course of health IT can’t be followed which is why interoperability is important, and they will guarantee that certified records will be backwards compatible and be interoperable. So he wants not to reward silos, but instead to reward “interoperability” for P4P — not to create optimal activity in a sub-optimal place.

Finally he wants P4P to be long term, not to die on the vine like capitation because it’s a new name for dumping the risk on someone else!

I asked Brailer about consumerism, HDHPs, and whether that is in conflict with integrated systems. He thinks that those integrated systems will find other solutions and they will integrate with other pieces of the system. Most other industries have moved away from “integration”… He believes IDS are closer to that end point in operation versus where they are psychologically. And closed systems are not totally closed. No one is an island. So they require interoperability, but he hopes those big systems can export their knowledge. So they need interoperability too. (he didn’t really touch on whether the HDHP will destroy the HMO movement before those consumer measures are created.

His final point? This is inevitable as doctors going into practice now will not tolerate paper in their practice. He wants the process of having this happen cleanly and not have it happen as islands.