expected to enhance consumer care. 80 Presumably (albeit not guaranteedly), 81 the problems with failure of interoperability of electronic health record (EHR) programs that have impeded timely, efficient, and accurate record sharing among disparate providers thus far82 would be eliminated when all parts of the single parent provider entity are using the same program. 83
III. EFFECTS OF LTSS CONSOLIDATION ON PARTICULAR POPULATION GROUPS
The preceding section set out, at an exceedingly broad and general level, some of the main expectations that might be reasonably foreseen as natural results of consolidation within the healthcare industry. In this section, I try to apply these general possibilities to particular distinguishable categories of people who might comprise the current universe of LTSS consumers in the U.S. Also in this section, I tentatively suggest a smattering of research questions that could be pursued to test the speculative possibilities identified here concerning the consolidation-LTSS relationship. The results of some the suggested empirical investigations should importantly inform the ongoing development of LTSS practice and policy.
A. Completely Self-Pay Population
Most Americans do a rather poor job of estimating, and planning effectively for, their future healthcare expenditures. 84 Nonetheless, some individuals pay entirely for their own LTSS out of their own pockets, either using personal pensions, savings, investments, and reverse mortgages85 or by
80. See generally Nicolas P. Terry, Certification and Meaningful Use: Reframing Adoption of Electronic Health Records as a Quality Imperative, 8 IND. HEALTH L. REV. 45 (2011); Brian Rothman et al., Future of Electronic Health Records: Implications for Decision Support, 79 MOUNT SINAI J. MED. 757 (2012). 81. See U.S. GOV’T ACCOUNTABILITY OFFICE, GAO-15-530, ELECTRONIC HEALTH RECORDS: OUTCOME-ORIENTED METRICS AND GOALS NEEDED TO GAUGE DOD’S AND VA’S PROGRESS IN ACHIEVING INTEROPERABILITY (2015) (reporting on EHR interoperability problems within two federal agencies). 82. See Marie-Pierre Gagnon et al., Barriers and Facilitators to Implementing Electronic Prescription: A Systematic Review of User Groups’ Perceptions, 21 J. AM. MED. INFORMATICS ASS’N 535 (2014); Carrie Anna McGinn et al., Comparison of User Groups’ Perspectives of Barriers and Facilitators to Implementing Electronic Health Records: A Systematic Review, 9 BMC MED. 46 (2011). 83. See Deth Sao et al., Interoperable Electronic Health Care Record: A Case for Adoption of a National Standard to Stem the Ongoing Health Care Crisis, 34 J. LEGAL MED. 55, 57-59 (2013) (explaining the efficiencies of the VA’s comprehensive EHR integrated infrastructure). 84. Allison K. Hoffman & Howell E. Jackson, Retiree Out-of-Pocket Healthcare Spending: A Study of Consumer Expectations and Policy Implications, 39 AM. J.L. & MED. 62 (2013). 85. See generally Jean Reilly, Reverse Mortgages: Backing Into the Future, 5 ELDER L.J.