BRIEF OVERVIEW

OF SUTTER HEALTH:Large, non-profit, integrated healthcare organization

Located in more than 100 Northern California communities
25 acute care hospitals
Multiple long term care, home health, outpatient entities
Aligned Physicians: Over 4,000
Majority owner: Omni Healthcare HMO
Employees: Over 31,000

QUESTIONS: Will focus on selected questions.

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#1. EXPECTED IMPACT ON HEALTHCARE PROVIDERS;

HOW WILL THESE ISSUES IMPACT OUR ORGANIZATION?:

· GENERAL: Administrative simplification provisions are well-intended, however, they may create added burdens for healthcare providers rather than making work "simpler". Timelines are very aggressive given such major change.

· INFORMATION TECHNOLOGY (I.T.): The I.T. challenges and costs will be major. Sutter is currently experiencing very high costs for new I.T. systems, major standardization complexity, and limitation in state-of-art technology for large healthcare systems. On a national level, these issues will be greatly compounded. Will vendors be able to supply cost-effective products timely?

· COSTS: Healthcare margins are very slim. Costs of converting current systems, modifying operations, and ensuring compliance will likely be expensive and time consuming. Who will pay for these costs?

UNIQUE IDENTIFIER: The creation of a unique, nation-wide individual identifier is an overwhelming challenge. Creates major confidentiality concerns.
CONFIDENTIALITY: Ensuring confidentiality from unauthorized external access while balancing the need to share clinical information across integrated healthcare systems will be very important.

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Presentation to National Committee on Vital & Health Statistics

Kay Franks

June 3, 1997

#2. CURRENT PRIORITIES - STANDARDS:

· Sutter is in the process of standardizing financial and clinical systems. Significant input, effort, time and cost is required to achieve standardization. Phased-in multiple year implementation is occurring.

#3. CONCERNS RE: TRANSACTIONS:

· ALL PAYERS/PROVIDERS: It is very important that all government and private payers/plans comply with requirements. "Exceptions" will create chaos for healthcare organizations transmitting data.

COMMON DEFINITIONS/STANDARDS: Achieving common definitions and standards will be a major challenge and will take time.
CLAIM ATTACHMENTS: Will need to eliminate current requirements for forwarding paper attachments with bills to payers. (Currently, must frequently send copies of authorizations, discharge summaries, operative reports, etc.) Transmitting such records electronically may be costly and time-consuming.

#5: BEST CODING APPROACH:

· Eliminate the current need for multiple procedural coding systems.

(ICD-9 & CPT)

#9: ADVICE/RECOMMENDATIONS RE: IMPLEMENTATION:

· Ensure all payers comply.