The healthcare-related provisions, folded into a much more expansive bill meant to boost the economy and stem the loss of jobs, represent an opening salvo to the reform discussion in Washington and could finally prove to be the vehicle that moves previously stuck health IT legislation. Health IT is going to lead the way, said Rep. Pete Stark (D-Calif.), chairman of the Ways and Means Health Subcommittee. One recently enacted health IT rule change is under review by the Obama administration.
The full House is expected to vote on the economic stimulus package on Jan. 28. Meantime, Sen. Max Baucus, chairman of the Senate Finance Committee, on Jan. 23 unveiled the Senates stimulus blueprint. Like the House version, it contains an $87 billion boost to the Medicaid program and would also deliver $17.9 billion for health IT.
The House Ways and Means portion of the bill, which passed the committee on a 24-13 vote, included amendments that stay CMS-drafted regulations that would have choked off capital indirect medical education payments and another that would have reduced hospice reimbursements.
The committee also added provisions that extend a moratorium on a handful of Medicaid and Medicare rules that would have lightened the coffers of teaching hospitals. Included in the legislation is a Medicaid rule that would have removed federal matching dollars for graduate medical education and another that would have narrowed the definition of a government-owned hospital.
The bill halts a regulation that would have cut about $175 million in Medicare capital indirect medical education payments. Such dollars go to teaching hospitals, which typically have a need for bigger and more flexible space than an average community hospital. Congress held some of those rules at bay last year in a massive supplemental bill, but the moratorium it enacted ends April 1. The new bill would extend the legislative hold until July 1.
Taken in total, however, the massive stimulus bill garnered opposition by many Republicans, who argue that it costs too much and doesnt directly show that it would boost employment. Rep. Dave Camp (R-Mich.), the senior Republican on Ways and Means, said that even the healthcare provisions draw scrutiny for their timing and cost.
Specifically, Camp said that the COBRA provisions were made without having had one employer come in to testify. As approved, the bill expands eligibility for the program, which is designed to help those who have lost their job keep and maintain their health insurance. It also lowers premium payments in the program. Camp also chided Democrats on the committee for drafting other health provisions before an HHS secretary has been confirmed.
Camp, however, agreed that the two parties share common ground on health IT. Still, he warned that some of the provisions were moving in advance of a set of common interoperability standards. And he questioned whether health IT should even be included in the $825 billion economic stimulus bill, saying that its not immediately clear how it would help stimulate the economy or grow jobs.
But most of the health IT debate was reserved for a marathon Energy and Commerce Committee session, which ran concurrently with Ways and Means proceedings and lasted late into the night. Both committees share jurisdiction over the bill. The Appropriations Committee, which controls the spending portion of the legislation, also approved the bill last week.
Fighting back a flurry of Republican amendments, the committee approved the measure that would make $20 billion available for the adoption and use of electronic health records. The bill would pay up to $65,000 per physician in provider incentive payments under Medicare and Medicaid programs.
Under terms set out in the bill, hospitals would be eligible for millions of dollars in incentive payments to become fully wired facilities. Conversely, providers that do not adopt health IT or do not use it effectively would face payment penalties starting in 2016. The Congressional Budget Office estimated that the health IT portion could increase adoption to 90% in the physician community and to about 70% in the hospital sector over the next 10 years.
The votes last week also clear the way for federally funded comparative effectiveness research. Overall, the legislation would allot $1.1 billion to spur comparative studies of medical devices, procedures or pharmaceuticals used to treat the same conditions.
Scott Gottlieb, a former senior adviser at CMS and deputy commissioner at the FDA and now a senior fellow at the American Enterprise Institute, said that the comparative effectiveness provision would ultimately fall short in practice. Gottlieb said that the money earmarked for the program doesnt dent the amount many expect would need to be in place to fund giant, long-term studies that would ultimately yield more than just surface data.
What do you think?
Write us with your comments. Via e-mail, its [email protected]
; by fax, 312-280-3183.