House passes bill encouraging health IT

Washington -- The House late last month approved legislation that would enable physicians to buy and receive donations of health information technology more easily.

But some doctors worry thatit would also force them to adopt a new diagnostic coding system without nearly enough lead time.

The Health Information Technology Promotion Act of 2006 passed the House on July 27 by a largely party-line vote of 270-148.

After Congress returns in September from its month-long summer recess, conferees from both houses will attempt to resolve the differences between the House bill and the Wired for Health Care Quality Act, a different version of the health IT bill that passed the Senate last year.

The American Medical Association supported the House bill as a whole and welcomed its passage. It has not taken an official position on the Senate measure.

The House legislation "is an important step forward to enhance physician access to health information technology," said AMA Board Chair Cecil B. Wilson, MD.

"The AMA shares widespread optimism over the promise that health information technology holds for improving patient care, if properly developed, implemented and financed," Dr. Wilson said.

But one of the provisions of the measure that has received less praise from doctors is a requirement that hospitals and physician offices upgrade to the ICD-10 coding system from the current ICD-9 system. (This bill has no impact on the CPT codes physician offices use to let payers know what treatments they administer.)

The first version of the House bill would have mandated that physicians and hospitals upgrade to ICD-10 by October 2009. After receiving complaints about this timeframe from a wide range of organizations representing doctors, practice managers and health plans, bill handlers pushed back this proposed deadline to October 2010.

But the one-year reprieve might not be enough for some physicians.

"The AMA remains concerned about the potential costs and administrative burdens in transitioning from ICD-9 to ICD-10, and we look forward to working with the conferees to resolve these issues," said Dr. Wilson.

The Association recently took a stand in the debate, voting at its Annual Meeting in June to support not only a delayed implementation schedule but also a modified version of the new system that would have a smaller number of diagnostic codes for physicians and hospitals to learn.

A coalition that includes the American Academy of Dermatology, the American Assn. of Neurological Surgeons, the BlueCross BlueShield Assn. and the Medical Group Management Assn., renewed its call for a three-year postponement of the requirement's original effective date. Senate legislation does not address the coding issue.

"As [the House legislation] goes to conference with the Senate-passed bill, the coalition is adamant that their members need until Oct. 1, 2012, to make the massive changes ICD-10 brings," the groups said in a statement. Both payers and physicians need at least three more years to update their technology and get up to speed on the much more complex set, which by some estimates would include more than 200,000 codes, they said. By comparison, ICD-9 has roughly 24,000 codes.

But hospitals, device manufacturers and some doctors say that the update is long overdue and will allow health professionals to coordinate patient care more effectively with each other and with payers. Modernizing the outdated coding system with one that provides much greater specificity for patient diagnoses goes hand in hand with the drive toward bringing all of health care into the digital realm, said Rep. Charles Boustany Jr., MD (R, La.), a cardiovascular and thoracic surgeon who voted to pass the House bill.

"Our nation leads the world in medical research and innovation, but American patients still remain trapped in a paper-based system that leads to duplicative tests and avoidable medical errors," he said following passage. "This legislation is a significant step in removing many of the barriers that have prevented health information technology from being implemented."

Bridging the gaps

As lawmakers prepare to take these competing stances into account during conference negotiations, they will also need to settle differences in several other key areas.

The House bill, for instance, would allow hospitals, group practices, Medicare managed care plans and prescription drug plans to donate health information technology to physicians under certain circumstances without violating federal anti-fraud and anti-kickback laws.

Such safe harbors, which are not present in the Senate legislation, are vital for relatively smaller physician practices and their patients to be able to benefit from the same modern technology as do the health care entities that have more resources, according to the AMA and other supporters of the changes.

Negotiators also need to determine what level of federal money should flow to doctors and other health care professionals to help them purchase electronic medical record systems and other types of health IT. The House measure would only commit $20 million in federal grants to eligible recipients over the next two years, while the Senate bill would spend more than $250 million over that same period and direct Congress to commit additional funding for the following three years.

But physicians and others hoping for a significant federal funding stream for health IT may run into opposition from the Bush administration, which issued a statement supporting passage of the House bill but added a caveat about the potential price tag of any final consensus.

"The administration is still assessing the cost of the bill and looks forward to working with Congress to ensure that it does not cause a net increase in spending," the White House statement says.