Changes In Attitudes

One of the main gripes we have about politicians is they say whatever is necessary to get elected, then largely act as their predecessors had. In short – we are left with, at worst, broken, at best, unfulfilled, campaign promises.

But the less nefarious and, thus, less satisfying reason for this eternal phenomenon is that campaign promises are, by their very nature, aspirational. They laudably aim at some semi-utopian state of affairs, but can only survive in the protective shell reserved for the un-implementable. These promises are, of course, un-implementable because the person advocating them is unable to move forward with their execution at the time they are being made. Talk is cheap.

If, however that individual attains the position being sought, they face the unpleasant prospect of having to face the consequences of those promised actions.

“But Mr. President, if we do that, this is what will likely happen.”

“Oh…really … well, we can’t have that.”

There is often a huge gulf between talking and doing, between proposing and executing, between “doing the right thing” and doing what is possible. The industry’s Meaningful Use experiment has provided a splendid test lab to study the tension between these two worlds.

To roughly divide the characters in this play between two camps, we have the wish listers on one side and the realists on the other. To a large extent, of course, the wish lister ranks are populated by those who will not have to adhere to the measures they put forth, while the other camp will. The wish listers are composed of special interest groups, often represented by experienced and capable advocates/lobbyists accustomed to exerting influence over regulative and legislative affairs. The realists are composed of those who must deal with the aftermath of these recommendations, NPRMs and, finally, final rules. On that side, we see the healthcare providers, payers and vendors.

While one basic exercise is to run down the list and put each name in one of the columns, far more fascinating is to notice those shifting from one camp to the other. Recently, I’ve noticed an influential wish lister inching toward the realist camp.

Faced with the now well-known Stage 2 Timing Glitch, Paul Tang, M.D., VP and CMIO at Palo Alto Medical Foundation and chair of the Meaningful Use workgroup, has been a strong proponent of some remedy or relief. Though he lives in the provider world, I would have previous described Tang as a wish lister, someone very interested in (perhaps too) aggressively catapulting the industry forward through the mechanism of Meaningful Use. But it seems the combination of being on the provider side; in a position of high responsibility and visibility in the Meaningful Use program (chair of the workgroup); and a good listener ever more sensitive to industry feedback, has caused Tang to seek a more moderate course.

What may be happening here is akin to an elected politician getting perilously close to enacting a campaign promise, and finally hearing his advisors and constituents warning, “If we do that, this is what will likely happen.”

In fact, even the likes of Dr. Ferdinand Velasco, CMIO at Texas Health Resources, who chides the industry for Meaningful Use “whining” in Part II of our Podcast interview, wants some Stage 2 timing remedy.

I never require perfection as a prerequisite of appreciation. But what does engender my respect, even admiration, is the ability to absorb critical feedback to the point one changes a strongly held position. While I don’t claim Tang has had such a Road to Damascus moment, there has been a noticeable change in his willingness to challenge, rather than champion, the Meaningful Use wish listers. To the extent that Tang is, in fact, ready to tone down Stage 2, he has my vote of approval.