If you come to a fork in the restaurant…

In Greek mythology, there was a not so nice man, Procrustes. He had an iron bed in which he invited wayfaring strangers to spend the night. Some of the strangers were too long for the bed and others were too short.

Apparently Procrustes liked things orderly and could be a tad anal when learning his guests did not fit. He would set on them with his smith’s hammer, to stretch the shorter ones to fit. If the guest proved too tall, Procrustes would amputate the excess length. Truth be told, nobody ever fit the bed exactly because Procrustes had two beds.

In contemporary terms, a Procrustean Bed is an arbitrary standard to which compliance is forced. A Procrustean Solution involves fitting a business problem to a preconceived set of strictures.

Raise your hand if you have already figured out where this is headed. Preconceived. Arbitrary. Compliance. Strictures.

Do you spell Meaningful Use with an upper case Procrustean or one in lower case? I prefer the upper case. The business problem being fitted is the implementation of EHR. The preconceived sets of strictures are the Meaningful Use standards.

This in turn leaves the healthcare provider in what is best described as a Morton’s Fork scenario. Shall I explain? A Morton’s Fork is a choice between two equally unattractive alternatives—a dilemma. The concept originated in 1487 under the rule of Henry the VII as a result of tax policy to ensure everyone paid taxes. The argument was because the rich had enough money to buy things they must have enough money to pay taxes, and the poor who had bought nothing had saved their money, and thus had money with which to pay taxes. The two prongs of the fork—back then forks only had two prongs. Q. E. D.

The healthcare provider must choose between—as one may not choose among—two alternatives. Attempt to meet Meaningful Use—a Procrustean Solution—turn their business model inside out to meet the government’s Gossamer standards.

Attempting to meet the standards does not ensure they will in fact meet the standards. Should they only meet ninety-nine percent of the standards, they lose. The Pareto principle does not apply. There is no 80:20 rule. They will not receive any incentive money as Meaningful Use is an all or nothing game.

The second alternative is to not meet Meaningful Use. This choice may be voluntary, or involuntary—trying to meet Meaningful Use and failing. Alternative Two—it is said—will result in reimbursement penalties from Medicaid and Medicare.

I do not think those penalties will be implemented, or at least they will not be implemented in the documented timeframe.

I also do not think there is a Morton’s Fork, because I think Meaningful Use will disappear because it is so arbitrary and capricious—and because the number of large providers who will meet it could all drive to lunch at Morton’s in a Yugo, at which time they could dine with a fork from Morton’s.

We have now come full circle. My work here is through.

Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy