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A witness to history in healthcare information technology.
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By Joseph Conn

Blog: GOP blustering about EHR program - There they go again

How can one respond to the news of four more Republicans writing another letter to HHS Secretary Kathleen Sebelius about the federal electronic health-record incentive payment program other than to invoke Ronald Reagan?

"There you go again."

In their Oct. 17 letter (PDF), Sens. Richard Burr (R-N.C.), Tom Coburn (R-Okla.), Pat Roberts (R-Kan.) and John Thune (R-S.D.) weren't as lopsided in their argument or as inflammatory in their rhetoric questioning the program as were their House counterparts, who, in an Oct. 4 letter accused the feds of "padding the numbers" of EHR adopters while alleging the program will squander taxpayers' dollars.

The senators in their letter also did what those House members should have done—in claiming thatthey didn't understand what was happening with the ongoing federal health information technology initiative, they asked for a meeting with the pros at HHS to try and get some answers.

That said, it's at least worth noting that, like their House counterparts, none of these four senators voted for the American Recovery and Reinvestment Act of 2009, which created the EHR incentive payment program.

And, like their House colleagues, their approach—inadvertently or intentionally, if anyone takes it seriously—could cause serious damage to the program.

In one bulleted item in the letter, the senators ask: "Have some healthcare providers received federal subsidies for EHR systems they already had in place prior to the adoption of federal standards and mandates? If so, what steps is the administration taking to recoup any inappropriate payments and what additional program integrity measures have been adopted?"

Sebelius' answer to the first question should be: "No—two times, no. There are no subsidies; there are only incentive payments. And there is no mandate. Providers are free to participate or take a pass on the incentive payment program, as the law provides. Of course, if providers don't become meaningful users, in good time they will see their Medicare reimbursements trimmed, also as the law requires—but that's not a mandate."

And Sebelius' answer to the second question ought to be: "We'll be taking no steps to recoup payments to providers with pre-2009 EHRs because they were not inappropriate under the publicly vetted rules of the program. That's because the program has always had two prongs: to incentivize EHR adoption and encourage the systems' 'meaningful use,' all with the dual aims of improving quality of care and reducing costs."

My guess is that the senators know all that, just as they also know that providers with EHRs before 2009 have received incentive payments. So, this all comes off as a thinly veiled threat to claw back payments already made to providers.

If HHS asks for that money back, it would wreak havoc on the program and further undermine the industry's already weak trust in government itself. The senators have to know that, too. So, one wonders if that wasn't their true intent.

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