DOT.GOV and amortize their administrative systems costs today. If the investment community knew that all government payers--and all providers exchanging revenue-critical data with those payers-would soon be required toinstall a new IT system based on the new standard, capital would flood the vendor community; the vendors'research and development(R&D), fixed, and selling costs would plummet; and the hit mar- ket would finally attain critical mass a Parallel mandatory conversion of providers transactions with govern ment payers to systems based on new clinical data standards. on the other side of the reimbursement table, the federal government should require that all pro viders adopt the same IT system to receive payment for all claims submitted for gov- ernmental reimbursement. Although initially expensive, this conversion would re sult in a massive reduction in the type and volume of paperwork required of providers in their interactions with government payers. For providers uninterested in these other benefits, unwilling to computerize their clinical activities, and wish ing only to comply with the new reimbursement processes integrated into the new standardized IT system, the vendor community would no doubt create a"reim bursement-only"version of the system, which the provider's traditional office staff could use. For the remainder of the patient's medical record, the provider would still be free to scrawl information into a chart or mumble it into a tape recorder, inadver tently helping to kill as many patients as they do today-although it is unlikely that that provider would be as popular with his or her patients going forward. a Safe harbor for hospitals purchases of the new system for physicians. Legislation compelling the adoption of the new systems should include clear, cate gorica relief from the anti-kickback and anti-self-referral laws that have historically blocked the widespread adoption of IT systems designed to allow physicians and hospitals to exchange clinical data. Laws passed years ago to prevent the unneces- sary admission of patients into conspiring facilities by a small minority of unscrupu- lous physicians have since kept all hospitals from building electronic bridges to any physicians who might admit patients into their facilities. Numerous observers, in- cluding the federal government itself, have remarked that these laws inadvertently shut down what could be one of the most efficient avenues for computerizing health care.37 As the WellPoint experiment indicates, most physicians want to computer- ize;they simply do not have the capital to pay for the systems and the one-time workflow disruptions. Hospitals have the capital, IT know-how, and administrative cost rationale to connect their referring physicians. Because the system would be based on open clinical standards, the fear that this provision would drive steerage to he hospital would be neutralized Such legislative relief would be helpful but would hardly quell the hysteria of the provider and payer lobbies, which, when confronted by this proposal, would scream on cue, "Unfunded mandate! The short answer to this objection is"yes The long answer, and one that will require considerable political courage, is this: A mandate is a mandate for all, and payers and providers will pass the initial cost of HEALTH AFFAIRS Volume 24, Number 5D o T - G o V and amortize their administrative systems costs today. If the investment community knew that all government payers—and all providers exchanging revenue-critical data with those payers—^would soon be required to install a new IT system based on the new standard, capital would flood the vendor community; the vendors' research and development (R&D), fixed, and selling costs would plummet; and the HIT mar￾ket would finally attain critical mass. • Parallel mandatory conversion of providers' transactions with govern￾ment payers to systems based on new ciinicai data standards. On the other side of the reimbursement table, the federal government should require that all pro￾viders adopt the same IT system to receive payment for all claims submitted for gov￾ernmental reimbursement. Although initially expensive, this conversion would re￾sult in a massive reduction in the type and volume of paperwork required of providers in their interactions with government payers. Eor providers uninterested in these other benefits, unwilling to computerize their clinical activities, and wash￾ing only to comply with the new reimbursement processes integrated into the new standardized IT system, the vendor community would no doubt create a "reim￾bursement-only" version of the system, which the provider's traditional office staff could use. Eor the remainder of the patient's medical record, the provider would still be free to scrawl information into a chart or mumble it into a tape recorder, inadver￾tently helping to kill as many patients as they do today—although it is unlikely that that provider would be as popular with his or her patients going forward. • Safe harbor for hospitals' purchases of the new system for physicians. Legislation compelling the adoption of the new systems should include clear, cate￾gorical rehef from the anti-kickback and anti-self-referral laws that have historically blocked the widespread adoption of IT systems designed to allow physicians and hospitals to exchange clinical data. Laws passed years ago to prevent the unneces￾sary admission of patients into conspiring facihties by a small minority of unscrupu￾lous physicians have since kept all hospitals from building electronic bridges to any physicians who might admit patients into their facihties. Numerous observers, in￾cluding the federal government itself, have remarked that these laws inadvertently shut down what could be one of the most efficient avenues for computerizing health care.^'' As the WellPoint experiment indicates, most physicians want to computer￾ize; they simply do not have the capital to pay for the systems and the one-time workflow disruptions. Hospitals have the capital, IT know-how, and administrative cost rationale to connect their referring physicians. Because the system would be based on open clinical standards, the fear that this provision would drive steerage to the hospital would be neutrahzed. Such legislative rehef would be helpful but would hardly quell the hysteria of the provider and payer lobbies, which, when confronted by this proposal, would scream on cue, "Unfunded mandate!" The short answer to this objection is "yes." The long answer, and one that will require considerable political courage, is this: A mandate is a mandate for all, and payers and providers will pass the initial cost of HEALTH AFFAIRS - Volume 24, Number 5 1259