Two years ago in June, Sens. Deborah Stabenow (D-Mich.) and Olympia Snowe (R-Maine) introduced a bill to do something no other legislators were willing to do at the timeput real money behind their support of driving the implementation of healthcare information technology.
OK, OK. Sens. Hillary Rodham Clinton (D-N.Y.) and Bill Frist (R-Tenn.) filed a bill later that month that called for spending $625 million over five years, but that was only a fraction of the $4 billion called for in the Stabenow-Snowe bill over the same period of time.
The money under the Clinton-Frist plan also was a spit in the ocean compared with the $98 billion needed for hospitals to reach an electronic medical-records system adoption rate of 90% over a 20-year period and the $17.2 billion needed to get 90% of physicians using EMRs, according to estimates in a RAND Corp. study released later that year.
Stabenow-Snowe, at least, would have provided a good down payment on what is needed for physician adoption, according to RAND.
Stabenow and Snowe were back Wednesday announcing the filing of an updated version of their old legislation, now called the Health Information Technology Act of 2007. The money is the same$4 billion over five years. The bill would provide money to fund IT acquisition grants to hospitals, long-term-care facilities, critical-access hospitals, federally qualified health centers, skilled-nursing facilities, community mental health centers, physicians and physician groups. It also would allow these organizations to accelerate depreciation of healthcare IT software and hardware for tax purposes and provide targeted Medicare payment boosts to providers that use IT to improve the quality of care to patients with chronic conditions.
Grants could be used to cover the costs of systems purchased after Dec. 31, 2006, through Sept. 30, 2012. The bill also instructs the HHS secretary, who would be awarding the grants, to give first priority to not-for-profit organizations that serve a high percentage of public-pay patients, then to for-profit organizations that do the same. Grant caps are $1 million for individual hospitals, $200,000 for skilled-nursing facilities, $150,000 for federally qualified health centers, $75,000 for community mental health centers, and $15,000 per physician either in solo or group practice. The bill would not alter the privacy rule under the Health Insurance Portability and Accountability Act of 1996, but it would require grantees to notify patients if their individually identifiable information is "wrongfully disclosed." Money drawn from the Medicare trust funds for hospitals and physicians would be used to pay for the program. At least 20% of all grant money has to go to rural or medically underserved communities.
The backers of the new bill thus far include more than a few powerful organizations. Their ranks include corporate giants and business associations such as General Motors Corp., Ford Motor Co. and the National Business Group on Health; major primary-care and specialty medical societies, such as the American College of Physicians, the American Academy of Pediatrics and the American College of Cardiology; IT vendors and their trade groups such as IBM, Oracle Corp. and the Healthcare Information and Management Systems Society; and various not-for-profit organizations, such as Families USA and the Detroit Medical Center.
American Medical Association Executive Vice President and Chief Executive Officer Michael Maves, in a letter to Stabenow Thursday, "commends" her for "understanding the impediments to HIT's adoption." And while not specifically endorsing the bill, Maves said, "We look forward to working with you on a number of provisions in the bill."
"There are 37 (supporters) right now," said Dave Roberts, who as vice president of government relations is the top legislative handicapper for Chicago-based HIMSS. "There were a lot more last time."
Last time, both the Stabenow-Snowe and Clinton-Frist bills faded early in the pack of IT bills introduced during the 109th Congress.
Still, Roberts is guardedly optimistic about the chances of the updated bill in the 110th Congress.
"I think that thing has legs this time, because the Democrats are in charge right now and in the Senate, I believe they want to put some money in this," Roberts said. The problem for thisand any other IT booster bill with real money behind itwill come in the House, where Democrats took over in January and promptly reinstituted the pay-as-you-go policy that the Republican majority had discarded, Roberts said.
Pay-as-you-go, also known as pay/go, means, "You can't spend any money without an offset," Roberts said. "You either have to increase taxes or cut some program" to pay for any new spending measure.
Wendell Primus, the healthcare policy adviser to House Speaker Nancy Pelosi (D-Calif.), was a featured speaker at a HIMSS-sponsored IT event in Washington Tuesday, Roberts said. "He said it's going to be difficult to put any new spending in for HIT programs," Roberts said. "It doesn't mean it's not going to be a priority."
One factor on the plus side for the Health Information Technology Act of 2007 this time is that co-sponsor Stabenow, is becoming a real leader on HIT on the Hill, Roberts said. At Tuesday's event, HIMSS presented Stabenow with its Federal Leadership Advocacy Award. On the minus side, as in 2005, the bill likely will vie for legislative attention amid a crowded field of other IT bills filed in both houses of Congress.
Another factor is the growing prowess of HIMSS as a lobbying organization. HIMSS held its annual foray on Capitol Hill this week, sending more than 250 IT vendors and users out to the offices of 215 legislators, Roberts said. At about 60% of those meetings, HIMSS folk met with the legislators themselves, he said.
Robert Tennant, a senior policy adviser at the Medical Group Management Association, is far more pessimistic about the prospects of the bill, saying the money issue will be huge. He gives the bill little chance of success unless it is tacked onto another piece of legislation, such as funding for the popular SCHIP program.
With the IT bills, HIMSS is working up its talking points to counter pay/go constraints by positioning them as investments, not merely spending measures.
HIMSS is thinking about talking to the Office of Management and Budget and the Congressional Budget Office "and convincing them this really is an investment," Roberts said. "We think there is a lot of good data we can show that there is value in the investment."
That is exactly where Stabenow is positioning her bill, according to her spokesman, Brent Colburn.
"Our feeling is that something that is technology-centered, you have to make the investment on the front end to get the benefits on the back end," Colburn said. While not nearly the spending levels called for by RAND, "We think it will get us started down this path."
Whether the White House will go along with the spending measure is another matter.
President Bush, in his executive order of 2004, set his administration's IT agenda by calling for most Americans to have access to their medical records in an electronic format by 2014 and creating the Office of the National Coordinator for Health Information Technology to oversee federal IT support efforts. Bush also imposed an expectation of frugality in ONCHIT's effort, an expectation that filtered down to the then-GOP-dominated Congress by insisting it do its work and "not assume or rely upon additional federal resources or spending to accomplish adoption of interoperable health information technology."
Colburn said the bills' sponsors are "hopeful" the White House will have a change of heart.
Stabenow, in a news release, cited the 2005 RAND study of the estimated costs and economic benefits of a national investment in healthcare IT, noting it "suggested savings as high as $81 billion a year."
The lead researcher on the RAND effort, which was funded by Cerner Corp., General Electric Co., Hewlett-Packard Co., Johnson & Johnson and Xerox Corp., was Richard Hillestad.
Hillestad said a few things have changed since the study was published, and perhaps spending priorities today might better be realigned to focus on office-based physicians.
"My understanding is the adoption of HIT, from the few things I've seen about it, is the hospitals seem to be moving forward but the physician adoption has sort of flattened out," Hillestad said. "The larger physician practices are adopting, but since half the physicians operate out of (solo and small group) practices, it's harder for them. It seems to me if you want to boost IT, that's where you should focus. If you want to leverage that (federal) money, you do it in a way where the smaller physician offices adopt the stuff."What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.