Developing a RHIO with no standardized models or processes

A RHIO is a return on investment plus shared benefits. The first step in getting there is pulling together the appropriate entities, said Bruce Fried, JD, partner at Sonnenschein Nath & Rosenthal LLP, during “If You Build It, They Will Come…But Then What?” at the RHIO Symposium yesterday at the Healthcare Information Management Systems Society (HIMSS) annual meeting in San Diego. “Pulling together entities is not easy work,” said Fried. You need to be clear about why everyone is in the room.

You must address key issues in forming a RHIO, such as its purpose, participants and leadership, business strategy, structure, organization, and funding, said Howard A Burde, JD, chair of the Health Law Group, Blank Rome LLP. These are important questions to ask because the answers lead to the organization, Burde said. Why should the RHIO exist? Who will benefit (not just profit)? What is the RHIO intended to do?
“A RHIO is a business,” said Fried. Even though there are few models for starting a RHIO, so like any other new business, the entrepreneurs still need a business plan.
To generate capital, Burde said, you need a pool of money and a regular stream of revenue. That may be taxes and user fees. Fried said he’d like to see more people exploring the option of funding their RHIO off the savings they’ll reap off the backend. “That’s the way energy efficiency initiatives have worked,” he pointed out.
Non-profits are the easiest to form and most of the existing RHIOs are nonprofits. That allows them to apply for grants, although a fully federally funded RHIO is unlikely, said Burde.
Aside from funding, liability and indemnification are big concerns for a RHIO. A RHIO can either be an operator or a sponsor. Burde recommends that RHIOs not be providers of content but rather serve as a bridge for information.
Most organizers aren’t seeing these as issues that need addressing upfront, said Fried. They should, he said, because “there are fundamental trust issues.”
The proposed Stark exceptions and proposed safe harbor regulations are another hurdle to establishing RHIOs. They have been “an impediment to HIT for more than four years,” said Fried. “We’ve had at least two false starts already. The [proposed exceptions and safe harbors] are poorly defined and there is no process articulated.” He also pointed out that when the OIG asks for comments, that typically means action takes another two years. Working through Congress may be the path of least resistance, he said.
The first step is your most important step to a successful RHIO, said Fried, whether that is e-prescribing or another IT component. “Pick your first thing carefully and make sure it succeeds. If you don’t succeed with the first thing, there’s not going to be a second chance.”