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What does it mean to think "out of the box"?

Traditionally, infrastructure or technology improvements among health centers are funded through savings accumulated through third-party reimbursement, non-operating revenues, and loan or grant programs associated with service or scope expansions. While these traditional sources should be explored and tapped to fund health IT, it is clear that few health centers will accrue sufficient savings to implement a major health IT system. Institutions that traditionally lend to health care providers, specifically health centers, may be reluctant to do so without a convincing business case that the investment will increase operational revenue.

Many policy makers point to "pay-for-performance" or "pay-for-use" reimbursement from payers as a retrospective means to recoup the costs of health IT implementation (they will receive enhanced reimbursement after the health IT investment). Pay-for-performance is a fairly new initiative in the market where providers are reimbursed by health insurers for meeting certain pre-established quality and efficiency measures. Pay for performance programs have been implemented by both private insurers and the Medicare program. In addition, the Centers for Medicare and Medicaid Services (CMS) have numerous demonstration projects underway, offering physician practices, clinics, and hospitals compensation for quality improvements. Additionally, demonstration projects involving adjustments to third-party reimbursement policies hold promise for subsidizing the cost of health IT adoption.

Resources:

• CMS EHR Demonstration Projects - Developed by the Centers for Medicare and Medicaid Services (CMS) (2008).  This is a link to press release by CMS about its EHR demonstration project.
• First Evaluation Report to Congress on Physician Group Demonstration Projects - Developed by CMS (2005).  This is a link to a press release by CMS about performance-based payments for its Physician Group Practice demonstration project.