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All But Inevitable

September 25, 2008
by Mark Hagland
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On the federal level, healthcare IT is one area where Republicans and Democrats can find common ground

Dennis Moore

Dennis Moore

Anyone not living under a rock during the past decade knows that relations between the two major national political parties have been contentious, with partisanship scuttling many pieces of legislation in the U.S. Congress. This partisanship means that the limited areas of “common ground” attract attention. One such area is healthcare IT.

In fact, if recent legislative developments are a harbinger, some movement in areas such as e-prescribing, financial support or incentives for EMR development — and perhaps pay-for-performance expansion under Medicare — seems very possible, say those in the know. Take for example the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331), which passed in both houses of Congress this summer, and sustained an override of President George W. Bush's veto. Among the numerous provisions of the bill, was a provision calling for financial incentives for e-prescribing, inserted into the legislation late in its gestation by Rep. Allyson Schwartz (D-Pa.).

“Getting the electronic prescribing element in the Medicare bill shows that the opportunity to improve accountability and quality, to save lives and to save money, is doable,” says Schwartz, who represents the 13th congressional district of Pennsylvania.

“Both parties are very interested in healthcare information technology and its use,” Schwartz continues. “All of the stakeholders are also very interested in leveraging information technology in order to improve the delivery of healthcare, and to provide more timely information to patients and providers.”

In terms of the specifics of federal funding for EMR development, Schwartz says, “I think there's a very high likelihood” of passage of such legislation either later this year or in the next Congress. “Of course, it depends on who the president is,” she says. “But we've made this a very high priority. There's increasing recognition of the tremendous value in this. And certainly, as a member of the Ways and Means Committee, I realize that Medicare needs to find ways to achieve quality and cost savings. And this is a tremendous opportunity to do both.”

Another member of the U.S. House of Representatives leading the charge on healthcare IT legislation is Rep. Dennis Moore (D.-Kan.). He says the time is ripe for legislation that will improve patient care, improve service to healthcare consumers, and make the healthcare system more efficient. Moore's bill, H.R. 2991, the Independent Health Record Trust Act, calls for patients to receive electronic copies of their records.

As Moore, who represents a suburban area of Kansas City, puts it, “This would allow the establishment of a nationwide system of electronic medical records.” In practice, if passed, Moore's bill could advance the cause of personal health records (PHRs), while leaving the broader issue of a nationwide EMR mandate untouched — though hinted at, unless more specific language were written into the bill after its passage.

In fact, “That same legislation is being implemented in the state of Washington,” notes Dave Roberts, vice president for government relations at the Healthcare Information and Management Systems Society (HIMSS, Chicago). “What's interesting is that (Moore) is proposing to have these independent repositories of health records around the country, and people would be able to plug into those,” says Roberts, who officially works out of HIMSs' Washington office in Arlington, Va., but is based in Solana Beach, Calif.

Meanwhile, in the Senate, John Kerry (D-Mass.) and John Ensign (R-Nev.) are cosponsoring S.B.2408 / H.R. 4295 (Rep. Schwartz is sponsoring the House version of the bill, H.R. 4295) which would give physicians a 1 percent bonus payment for every claim submitted based on an e-prescription. The legislation, known as the Medicare Electronic Medication and Safety Protection Act, also would impose a pre-claim financial penalty on physicians who continue to handwrite prescriptions as of Jan. 1, 2011, though it would also give the Department of Health and Human Services the authority to grant one- or two-year hardship waivers for individual physicians.

During a Dec. 5 press conference in Washington announcing the introduction of the legislation, Kerry said, “Electronic prescribing does save lives, it does save money, and it is an enormously effective way of beginning to move toward the information technology age.” Kerry's press secretary, Whitney Smith, adds, “Bringing the healthcare system into the 21st century's digital age is a top priority for Sen. Kerry. The eRx law shows that Democrats and Republicans can stand together to modernize healthcare, saving lives and money. The next step is to use the eRx carrot-and-stick approach to drive broader adoption of health IT, including computerized physician order entry in hospitals and fully functional and interoperable electronic medical records.”

Not surprisingly, this bill was easy for members of the opposite party to sign onto. As Tory Mazzola, communications director for Ensign put it, “Too often, when the issue of healthcare comes up, it falls along partisan lines, because quite frankly, the Democrats keep trying to push government-sponsored, Washington-controlled healthcare. Senator Ensign disagrees with that. Fortunately, e-prescribing is one of the issues that doesn't fall along those lines; it has broad bipartisan support. And fortunately, it makes passage much more likely.”

Roberts says areas such as e-prescribing and personal health records are ripe for legislation on Capitol Hill, given their easy bipartisan flavor. Nonetheless, he says, healthcare IT legislation will inevitably come under the broader umbrella of overall healthcare reform when a new administration comes into the White House and a new Congress is seated in January. “The window for passing legislation this fall is very slim,” Roberts says, though he believes that the Wired Act, S. B. 1693 (see sidebar) and the Pro(tech) Act, H.R. 6357, have some chance. “But when a new administration and Congress come in next year, once the administration people are confirmed and Congress gets organized, the bigger picture will be healthcare reform, and HIT will be a part of that debate.”

As a result, he says, “At HIMSS, we're establishing a work group, and we believe that no matter who wins, Sen. (John) McCain or Sen. (Barack) Obama, there will be an infusion of funding into healthcare IT. That was seen as a negative about the Bush administration, that while they provided leadership, they weren't providing funding.”

Roberts says he and his colleagues at HIMSS believe that healthcare CIOs and IT executives can play a significant role in providing expertise on the intricacies of healthcare IT for Congress and the White House, and can help to influence the specifics of any legislation that emerges. “The devil is absolutely in the details” when it comes to federal legislation, he emphasizes. And he says it behooves healthcare IT executives to play a part in the shaping of legislation that could have massive effects on the industry.

Meanwhile, the fate of the most extensive healthcare IT-related legislation hangs in the balance, with the specifics of what might pass in the next Congress really depending on both who the next President is, and which party controls Congress, says Roberts. Specifically, he is referring to S.B. 1693, the “Wired for Healthcare Quality Act: a bill to enhance the adoption of a nationwide interoperable health information technology system, and to improve the quality and reduce the costs of healthcare in the United States,” sponsored by Sen. Edward Kennedy (D-Mass.), with 15 cosponsors (including Republicans Susan Collins, Orrin Hatch, and Elizabeth Dole, and Democrats Barack Obama, Hillary Clinton, and Herb Kohl).

S.B. 1693 has passed in the Senate, but has failed to clear the House. And though most of its provisions, including the establishment of a nationwide healthcare IT infrastructure, the creation of a national IT coordinator for healthcare, and the authorizing of grant funding for HIT development, are relatively non-controversial, some of its implications have stirred debate. Roberts says the key areas of controversy include questions over privacy and consumer empowerment, which have raised concerns among individuals in both parties. Thus, he says, even relatively non-controversial bills can run into complications on Capitol Hill.

Movement expected, regardless of winner

All that having been said, Roberts fully expects that important healthcare IT-related legislation will pass in the next Congress, regardless of who is president. On the one hand, it is widely believed that Obama would bring about more sweeping change to the healthcare system than McCain, especially as Obama is calling for universal health coverage and other health system changes. But both have called for improving the efficiency and quality of the healthcare system and of patient care, and both have called for the use of information technology to achieve those aims.

Given the tremendous potential for federal legislation to be introduced, and possibly passed, those involved in the federal legislative process say it's essential for CIOs and other healthcare IT executives to get educated and get involved. For example, a national EMR mandate might emerge in legislation at some point; even the growth of incentives for EMR implementation could reshape healthcare, observers point out.

“I'm not sure whether we'll move to an explicit EMR mandate,” says HIMSs' Roberts, “but just as with the banking industry, we'll move towards incentives to get people to move forward. But until we can resolve privacy and security debates, we won't get there. That will be the big obstacle to get over. And that's where CIOs and health IT executives should be involved,” he urges. “And they need to vote on Nov. 4 at the federal, state, and local levels.”

HIMSS is not sitting the election out by any means. Among other areas, Roberts and his colleagues have been working with both presidential campaigns to try to get healthcare IT plans into the two major national parties' platforms.

And the politicians themselves encourage healthcare IT executives to get involved. “Healthcare IT executives should absolutely participate” in the process, says Rep. Moore of Kansas. “We don't want to pass anything that wouldn't improve healthcare delivery.” Adds Pennsylvania's Rep. Schwartz, “We want to learn from the experience of those who have been doing things, whether it's Kaiser Permanente or the state of New York or Geisinger Health System. I would ask CIOs to be engaged, and to work with us on these issues.”

Among the issues that Schwartz says are definitely under consideration, and which she and her colleagues would like CIOs to be involved in, are federal healthcare IT standards, financial incentives, support for IT development, federal endorsement of comparative effectiveness data, and pay-for-performance adoption on a Medicare program-wide level. In addition, she says, “CIOs can also work with their national associations, inform their members of Congress, and be a knowledge resource to those of us actively involved in these issues.”

Healthcare Informatics 2008 October;25(10):50-53

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