So the good news for federal IT planners is that survey respondents are finally warming up to one of their adoption-booster initiatives. In August 2006, HHS and the CMS approved waivers from federal anti-kickback and Stark self-referral laws for hospitals that help subsidize EHR systems for affiliated physicians.
Asked if their hospital has extended IT benefits to physicians under the waiver program, 41.4% of respondents indicated they had, while 58.6% said they had not. Those who said no were then asked if their organizations would extend IT benefits to physicians within the next 24 months, the yea-sayers increased to 49.5% and the nay-sayers fell to 50.5%.
The percentages of Modern Healthcare survey respondents who indicated a willingness to participate in physician-subsidy programs under the Stark and anti-kickback waivers have remained consistent across three years worth of surveys. Last year and the year before, when the programs were proposed but the final regulations had either not been announced or had only recently been announced, roughly 70% of respondents indicated they would participate in a physician-subsidy program.
Robert Kolodner is a leader of federal IT development efforts at HHS as head of the Office of the National Coordinator for Health Information Technology. Even given that the survey reflects a self-selected sample, Kolodner expressed satisfaction with the level of support for the Stark and anti-kickback waivers.
Thats tremendous, because were not looking for any one intervention to do the whole thing, Kolodner says. Were very pleased with that response and that degree of interest.
As to the strong preference for subsidies, Its still early in the process, Kolodner says. We didnt expect to have a great impact on the small doctors office. At this point in time, the interventions that weve done up to now havent had the impact on that segment of the population.
Last year, HHS and the CMS launched a pilot program to provide enhanced Medicare payments to a target group of physicians who in turn must report quality measures using an EHR. That program, he says, really is aimed at the small and medium-sized practices. They (the CMS) graduated the increasing requirements over a five-year period in order to receive the supplemental payment. Thats what were currently looking at in terms of a mechanism to provide physicians with additional payments that can be used to offset the cost of EMRs. Its tied to results. Thats different than: Are you getting something for free?
Others still consider as inadequate the level of government support for IT subsidies.
William Bria is the chief medical information officer for the Shriners Hospitals for Children system. The Tampa, Fla.-based pulmonologist is chairman of the Association of Medical Directors of Information Systems, a not-for-profit professional organization for physician informaticists.
Bria says he looks at IT infrastructure as a public good, which requires federal subsidies as do airports, commuter rail service and the interstate highway system, so, similarly, healthcare should not rely on market forces to build a national information network.
Whats obvious from anybodys numbers about penetration of the market and effective use throughout the country, it just hasnt worked, Bria says. I practice at (a Veterans Affairs Department facility) a couple of days a month, and the concept of practice at a government-run facility, its not nirvana. But the VA has an IT system that is based on common standards and makes its system interoperable. The same happened with standards for billing and payment when the CMS promoted electronic standards for claims transactions.
People quickly figured it out, and they made the change and we went forward, Bria says. The government is now working on standards development for clinical transactions, but, he says, the last step, where it takes some investment, we havent done yet.
Bria adds: Now, its tough going because weve got a financial crisis in the country, spending on the war, the budget deficits, but making this a subsidized thing I think is long overdue. In addition to financial support, federal subsidies could be tied to adoption of standards for information exchange and accelerate their adoption, Bria says.
The need for interoperability was urgent several years ago, Bria says. Now, the way people seek their care, the idea of gaining interoperability is not a nicety; its a safety and quality issue. I absolutely hope the government will subsidize it. It should have been done yesterday, and I hope that with a change of leadership that will happen. This is no longer a geek scream.