When it comes to healthcare information technology, the federal government should encourage hospital-physician connections, and to that end some revisions in the Stark and antikickback laws are now in order.
More on that in a minute, but first meet Arnold Wagner Jr., M.D., the physician champion behind the award-winning IT effort at Evanston (Ill.) Northwestern Healthcare in suburban Chicago. Wagner has been chairman of the medical informatics steering committee at the system since 1999.
The Health Information Management Systems Society in October gave Evanston Northwestern its 2004 Davies Award of Excellence in the organizational category for the installation of a $35 million clinical IT system from Epic Systems Corp. at the system's three acute-care hospitals and 65 hospital-owned clinics.
What makes Wagner's story remarkable is he is not one of the system's 550 physicians, but an OB/GYN in an independent five-physician group. But Wagner and his colleagues at Evanston Northwestern still have a couple of IT mountains to climb.
In February, the Federal Trade Commission alleged that the 2000 union of Highland Park (Ill.) Hospital with the system's Evanston and Glenbrook, Ill., hospitals was followed by anticompetitive price increases. The FTC complaint said that after the merger of Highland Park's Independent Physician Group and hospital-owned ENH Medical Group, the system fixed prices by illegally negotiating on behalf of independent, nonemployed physicians.
The government is calling for the divestment of Highland Park Hospital. System officials say they've done nothing wrong. The case is scheduled for a hearing early next year.
With that antitrust case looming, Wagner still sees it as his next great mission to proselytize the system's 1,100 affiliated physicians until they buy into the program to create one big happy, interconnected clinical community.
So far, Wagner's group is the only Evanston Northwestern-affiliated practice using the system. Two other groups, of four and eight doctors, plan to roll it out in mid-January, he says. The cost is $6,000 per doctor per year for two years. Wagner argues it's a bargain for a top-rated system but admits the cost is still too high for most one- and two-doctor practices.
"We are trying to get that number lower," he says, but the hospital is wary of adding federal antikickback and Stark problems to their antitrust woes. With good reason, according to Bruce Fried, a partner in the Washington, D.C., law firm of Sonnenschein Nath & Rosenthal.
The Medicare Modernization Act created safe harbors from Stark and antikickback laws to boost adoption of electronic prescribing systems, but Fried says the law is so narrow it may do little to promote IT agreements.
Fried says CMS Administrator Mark McClellan, M.D., last month told him that fraud and abuse laws were a problem, "so he said striking a balance is what they're after." The CMS should issue regulations on the Medicare act's e-prescribing law within 60 days, he says.
The CMS' new guidance on Stark provides exemptions for community health IT networks, but Fried says it hobbles IT efforts, too, in that it requires the networks to be accessible to all patients and providers. "No network in the country meets that criteria, and you have to be in compliance with the antikickback act, and so you just undid yourself," he says.
So there it is: The Stark and antikickback laws stand in the way of IT expansion, and the exemptions, as they now appear, apparently don't provide meaningful relief.
The good news is, it won't take an act of Congress to level both of these speed bumps.
The authority to create exemptions and safe harbors that would allow hospitals to offer full clinical IT systems to affiliated physicians at below-market prices was given to the HHS secretary under the Medicare act and the broader fraud and abuse laws, Fried says.
HHS Secretary Tommy Thompson, McClellan and their attorneys need to get busy on the seesaw and find that balance as soon as possible. The greater public good resides not in antitrust and Stark enforcement in these areas, but in the deployment of these systems as rapidly as possible.
According to American Medical Association data, 44% of patient-care physicians are in practices with just one or two doctors. They most need help buying and operating IT systems. But for all groups, government regulations should make it easier, not harder, for them to get that help.