Congressional Budget Office Director Peter Orszag on Wednesday told members of a House panel that if they want doctors to more quickly adopt electronic health records and electronic prescribing, then they should tie usage back to Medicare reimbursement rather than offer small financial subsidies.
You could very quickly get to universal health IT if you say to doctors that you have so many years to adopt such systems, or you would not be reimbursed under Medicare, Orszag said.
Since taking the reins at the CBO in 2007, Orszag has made healthcare policyespecially from an economic perspectivea top priority at the agency.
Testifying before the House Budget Committee, Orszag told lawmakers that federal subsidies for health IT tend to help only those physicians who are already close to upgrading their systems, but conversely do little to sway those doctors who are on the fence about implementing the often costly technology.
Tying Medicare dollars to usage would guarantee a higher adoption rateand at a quicker clip than subsidies would, he said.
The hearing, held by the House Budget Committee, intended to look at ways to increase the value of federal spending on healthcare.
More broadly, Orszag tamped down the high expectations many have for health IT, saying that it holds the most promise when used as a tool for comparing what medical services work bestand which ones dont work at allrather than as a means to correct systemic problems throughout the industry.
The director told members of Congress that introducing EHRs or e-prescriptions into a system that is already broken would do little to improve quality and efficiency.
The evidence on health IT actually generating improvement of efficiencies is more impressive on more integrated systems where information coming out of a system is used to evaluate the procedures and then push back on the providers' evidence of what works or what doesnt, Orszag said.
Its an assessment that Orszag has expressed before despite taking heat from health IT advocates for doing so. Rep. Allyson Schwartz (D-Pa.), who helped push through an e-prescribing measure as part of a Medicare bill that cleared Congress earlier this week, challenged the CBO directors statement.
Schwartz said that an increased use of modern technology in the physician office and hospital setting would go a long way toward stanching medical errors, and as a result would improve quality and ultimately drive down costs.
While not a panacea, it is a tool that we ought to look seriously at, Schwartz said.
David Gratzer, a senior fellow at the Manhattan Institute, said that the U.S. healthcare systems reliance on paper records harkens back to the days of the Pony Express. But Gratzer also warned that the savings predicted by some health IT proponents could prove to be on the high side.
I would point out that in both the Canadian and Danish experience, you dont quite get the cost savings that people are predicting, Gratzer said.
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