Like never before, healthcare information technology has become a hot topic on Capitol Hill and in the White House. President Bush advanced the cause when he set the goal of equipping everyone in the nation with a personal, portable electronic medical record within 10 years.
On Capitol Hill, at least five bills encouraging adoption of new systems and set information exchange standards are pending. The most recent is legislation introduced by Sen. Edward Kennedy (D-Mass.), the first to formally propose directly linking payment incentives to providers' use of IT.
Some prominent lawmakers see no other way to reach the ambitious goal of widespread adoption.
Kennedy's bill would offer larger payments to hospitals and doctors that use new information technologies such as electronic medical records and automated billing systems. Over time, Kennedy said, his bill would cut payments to large healthcare facilities failing to take advantage of IT systems that can improve quality while controlling administrative and clinical costs. "Arbitrary cutbacks for hard-pressed hospitals and physicians are the wrong remedy" for reducing healthcare cost growth, Kennedy said in a news release.
The federal reimbursement system "is very old-fashioned," says Rep. Nancy Johnson (R-Conn.), chairwoman of the House Ways and Means Committee's health subcommittee. "If we continue to pay that way, we will not be able to spread technology through the system." Referring to Bush's 10-year goal for broad adoption of electronic records, "We can't take 10 years, with all due respect," Johnson says.
Johnson is one of several lawmakers who has sponsored healthcare IT legislation in recent months. Johnson's bill--introduced in July 2003 and co-sponsored by two Democrats and 14 Republicans--would, among other things, direct HHS to develop a strategic plan for building a modern healthcare IT infrastructure.
Kennedy's bill would set the goal of broadly implementing electronic health records by 2011, three years earlier than the president's goal. Kennedy says his bill would create a healthcare system that pays for value rather than procedures and illnesses. The bill would tell HHS to set quality standards and would require both public and private payers to reward providers that reach such standards with higher payments--as well as punish those who don't with lower payments. If it becomes law, Kennedy's bill will authorize unspecified grants and loans to help providers install the often-expensive technology.
The prospects of signing any bill into law are not good in a year when lawmakers' attention is distracted by issues involving the war in Iraq and the upcoming election.
"It's tough to talk about additional legislation this year," House Ways and Means Committee Chairman Bill Thomas (R-Calif.) says. "We're just now beginning to see implementation of the Medicare bill."That bill, which became law last December, takes preliminary steps toward greater industry automation. Among other things, the law requires HHS to develop electronic-prescribing standards by Sept. 1, 2005; establishes the Commission on Systemic Interoperability to guide adoption and standards strategy for information technology; and authorizes grants to help physicians buy and install electronic prescription drug programs.
"This is not a discussion about IT per se but a discussion about how you transform patient care, quality and value and use IT to serve that master," says Jack Ebeler, president and chief executive officer of the Alliance of Community Health Plans, which is working with its members from the Advancing Better Care Project to promote quality reporting, self-care and effective use of IT.
-- with Tony Fong
