While small physician practices evaluate a baffling array of software options, skirmish with dodgy vendors, and crunch the numbers on training, hardware, and consulting, not to mention the mysterious and looming criteria of "meaningful use", President Barack Obama continually points to Utah's Intermountain Healthcare as a model for reform. But does the hospital, located in sunny Salt Lake, really represent the future, or is its presidential status a result of mere statistical manipulation and political maneuvering?

A recent article in the Salt Lake Tribue entitled "Intermountain Healthcare: A model system?" garnered heavy feedback. Out of 60 some comments, mostly be resident Utahns, only a handful were in support of the hospital. The rest all had a bone to pick with the "model" system:

We shell out 1200/month to IHC for a family of 4. And we are all reasonably healthy. No cancer, no diabetes, no heart disease. Just age creeping up, I don't know how "affordable" $14,000+ per year is. -Mona Lisa

The only problem with having a two-faced company like IHC (the face of healthcare and the face of insurance) is it gives them reduced incentive to work with other insurance companies. Since my employer does not offer IHC insurance, I'm forced to go to a hospital elsewhere. -ecgtheow

If IHC is truly a non-profit... let's look at the salaries - top down - just like we do government employees. How many are six figure and up? Publish them all, Salt Lake Tribune. -mlb

Apparently, not everyone is on board with President Obama's glowing review.

Despite having some of the most advanced EHR technology in the world, Intermountain Healthcare uncomfortably reveals a core problem with health reform: improving care reduces a hospital's bottom line.

Take for example a 2001 IHC initiative developed to curtail early-term deliveries. Intermountain analyzed nearly 18,000 births and found that babies born at 37 weeks had a 22.5 times higher incidence of severe respiratory distress, which resulted in longer hospital stays. To halt the practice, a delivery program called StorkBytes was programmed to capture data and trigger electronic alerts. Within six months the rate of early elective deliveries dropped by 10 percent, and eight years later the total number is less than 3 percent.

But not surprisingly, Intermountain lost money.

Performing fewer early term deliveries meant shorter lengths of stay. NICU admissions dropped, and patients received fewer lab tests, antibiotics and Caesarean-section surgeries. "The bottom line to our cost was significant," said Janie Wilson, operations director of Women and Newborn Clinical Programs. An analysis revealed Intermountain lost $3.3 million in net revenue between 2001 and 2005, a direct result of improved care.

Regardless, the IHC model does offer hope for health reform. A 2008 white paper (PDF) by Dartmouth College, using Intermountain as a benchmark, predicted up to 40% savings if all health systems followed their lead. And there is no doubt that EHRs are the cornerstone for reducing costs and improving care.

Intermountain is currently in the midst of a 10-year development project with General Electric to develop a new IT system called ECIS. "In most instances people are pushed in a gray area," says Greg Poulsen, Intermountain's senior vice president, "and data makes gray areas less gray."

Indeed, even after controlling for demographics, Utah boasts the lowest per capita healthcare costs in the country. In August a team from the federal Office of Management and Budget visited Intermountain to explore its model for American health reform. And IHC does have its supporters. Other comments from the article:

I will say that the two things IHC does very well (at least in my experience) are hiring doctors/nurses who actually know what they're doing, and their ability to keep track of your history so that they can diagnose and treat you based on FACT. In these regards, IHC is a shining beacon of how awesome healthcare could be. -r1v3t3d

I think IHC is doing a great job. You can challenge your bills if you feel that it is an unreasonable charge above and beyond your insurance. Sometimes just asking the question helps them understand what they can do better. -ammon1953

As the debate over healthcare reform rages on, it is important to analyze not only what these "example" health systems are doing right, but also what they are doing wrong.

Hospitals find themselves victim to a unique contradiction: improving business reduces profits. Meanwhile, some have opted out of the debate completely. Writes one commenter, Grizz60, "would not know cant afford health insurance!"