Doctors could get federal funds for IT
■ Senate legislation would establish a funding stream for health information technology. Sponsors drop a Stark law exemption.
By David Glendinning — Posted Aug. 8, 2005
Washington -- Bipartisan legislation that would establish tens of millions of dollars in information technology grants to physicians and other medical professionals is leading the pack of health IT bills on Capitol Hill.
The Wired for Health Care Quality Act, which has garnered significant support from Republicans and Democrats, passed the Senate Health, Education, Labor and Pensions Committee in late July. At press time, bill handlers were preparing the measure for a vote on the Senate floor.
If Congress and President Bush approve the bill, it would establish a funding stream of $125 million starting in fiscal year 2006 for IT grants to health professionals. The figure would increase to $150 million in 2007, after which lawmakers would decide how much to devote to the technology grants in each annual budget.
Sen. Edward Kennedy (D, Mass.), the ranking member on the health committee and co-author of one of the two bipartisan bills merged to create the consensus measure, said federal assistance for cash-strapped health professionals was long overdue.
"Currently, physicians and other care providers face information overload and a fragmented medical system where information is not available when needed," he said. "We would not expect a pilot to land a jumbo jet without a computer, but we expect physicians to keep in their heads the thousands of treatments they might prescribe and the effects of combining each of them. No wonder the system occasionally breaks down."
AMA says IT aid is necessary
The American Medical Association has not yet completed its review of the Senate legislation, but health IT remains an issue that has the Association's serious attention.
The AMA House of Delegates pledged at its Annual Meeting in June to "support legislation and other appropriate initiatives that provide positive incentives for physicians to acquire health information technology."
Although the Association has not weighed in on the size of the funding stream itself, doctors believe that some financial help is needed, said AMA Trustee Robert Wah, MD. Physicians might be loath to front all of the needed cash themselves if they feel that the cost savings will flow away from their practice to hospitals, insurers or other entities, he said.
"Health IT requires capital investment," said Dr. Wah, a reproductive endocrinologist and director of information management for the military health system. "To expect a small business like a physician practice to make that capital investment on its own and have somebody else get the returns for that capital investment is not a sustainable process."
If the bill is enacted, physicians could take advantage of federal IT funding in one of three ways. Individuals or group practices could apply directly to the government for competitive grants, request a new type of federal-state loan product or seek assistance from a regional health IT organization. Some of the options would require matching funds from a hospital system, health plan, state government or other non-federal source.
Stark law exemption dropped
Despite coming to agreement on the funding issue, bill sponsors were forced to back off another aspect of the legislation that would make it easier for doctors to obtain IT help from other sources.
Physicians say that private-sector entities such as hospitals and insurers have a strong financial incentive to help speed the adoption of health IT because they will share in any cost savings that result. But laws designed to minimize conflicts of interest within the system have served as barriers to these investments, they say.
Such barriers led AMA delegates to approve a resolution at their Annual Meeting in June calling on the Association to "pursue legislative and regulatory changes to obtain an exception to any and all laws that would otherwise prohibit financial assistance to physicians purchasing [health] IT."
Health, Education, Labor and Pensions Committee Chair Mike Enzi (R, Wyo.) and Kennedy helped draft a narrow exemption to the physician self-referral statute, known as the Stark law, and anti-kickback statutes to allow a doctor to receive free or discounted technology from a health care entity without running afoul of the prohibitions. But Enzi removed the language upon merging his bill with one authored by Senate Majority Leader Bill Frist, MD (R, Tenn.), and Sen. Hillary Rodham Clinton (D, N.Y.) because it encroached on the jurisdiction of the Senate Finance Committee. Aides said Finance leaders might restore the exemption clause before the full chamber approves the bill.
In spite of the issues that lawmakers still need to resolve, the Wired for Health Care Quality Act has risen to the top of the pile of health information technology bills introduced since the beginning of this year. At least five other IT measures are currently pending in the House and Senate. Dr. Frist said he wanted to consider input from other sponsors before moving ahead with one single bill that Congress could get behind.
The consensus legislation, which at press time had no companion bill in the House, also received a nod from the Bush administration. Dept. of Health and Human Services Secretary Michael Leavitt told reporters the Senate bill would support efforts under way at HHS to promote adoption of information technology. The measure would codify the HHS health IT office and an HHS-sponsored public-private commission to develop IT interoperability standards.