House stimulus bill boosts health IT, Medicaid

Washington -- A House-adopted $819.5 billion economic stimulus bill promises to boost state Medicaid programs, help unemployed workers keep health coverage, and assist physicians, hospitals and community health centers with the cost of implementing health information technology.

The House approved the measure on Jan. 28 without a single Republican vote, despite President Obama's calls for bipartisan support. Eleven Democrats joined Republicans in opposing the measure, known as the American Recovery and Reinvestment Act of 2009. At press time in early February, the Senate was considering a version of the stimulus bill with similar health spending.

During his weekly address on Jan. 31, Obama asked senators from both parties to adopt the stimulus bill. "With the stakes so high, we simply cannot afford the same old gridlock and partisan posturing in Washington," he said.

The American Medical Association applauded the House measure's investments in health care, including health IT, according to a Jan. 23 letter to House Speaker Nancy Pelosi (D, Calif.) from AMA Executive Vice President and Chief Executive Officer Michael D. Maves, MD, MBA. "When implemented properly in a connected environment, widespread [health IT] adoption will transform the practice of medicine," Dr. Maves wrote.

Ted Epperly, MD, president of the American Academy of Family Physicians, also welcomed the bill. "This is a great harbinger of what's to come in terms of what the priorities are," he said.

Most of the House measure's spending would support tax cuts, tax credits or infrastructure projects. But more than $150 billion would be split among various health care priorities, including about $90 billion to increase the federal share of Medicaid funding through 2010, $40 billion to extend health insurance coverage to unemployed workers and $20 billion in health IT adoption incentives.

House Republicans criticized the bill for spending too much on projects that will take years to complete or that would not create jobs. They cited a Congressional Budget Office report estimating that only about 65% of the spending in the House bill as adopted would be out the door by Sept. 30, 2010, the end of fiscal 2010.

House Minority Leader John Boehner (R, Ohio) said bill language providing hundreds of millions of dollars to the Centers for Disease Control and Prevention for facility renovations would only make bigger bureaucracies, not create jobs. "While it certainly has some good provisions, [the bill] has a lot of wasteful spending, a lot of slow-moving government spending in it," Boehner said.

Rep. Heath Shuler (D, N.C.) was one of the 11 Democrats who agreed with Republicans that the bill did not have the right priorities. Shuler worried that the measure would not be paid for with new revenues and would help propel the national debt to $11 trillion. "I cannot in good conscience borrow and spend $825 billion, further burdening future generations of Americans," he said.

Carrots, sticks for health IT

The House stimulus calls for a system of Medicare and Medicaid bonuses and penalties to encourage health IT adoption. However, it does not specify how much of the $20 billion in spending would go to physician practices as opposed to hospitals or community health centers.

The measure would provide up to $41,000 in Medicare incentive payments and $65,000 in Medicaid incentives for health professionals, including physicians, who use health IT to a sufficient degree and who see a relatively high volume of patients. Dr. Epperly said he didn't understand why the bill included this disparity between the two amounts. "We believe that ought to be a single figure."

The measure also would reduce the Medicare pay of health professionals who do not use health IT at a meaningful level. The reductions would begin with a 1% cut in 2016 and phase up to a total yearly cut of 3% by 2018. Dr. Epperly said that could be difficult for some physicians to absorb.

The bill would charge the National Coordinator for Health Information Technology and a Health IT Standards Committee under the Dept. of Health and Human Services with guiding spending by developing health IT standards to improve health care quality, efficiency and consistency.

Deborah C. Peel, MD, founder of the Coalition for Patient Privacy, on Jan. 19 wrote to a bipartisan group of nine House leaders urging them to ensure that medical data shared electronically will only be used to improve patients' health. "If we fail to ensure privacy and engender trust, Americans will avoid participation, or worse, avoid care altogether and undoubtedly misrepresent their medical histories," she said.

But some of the health IT provisions in the stimulus bill are overprotective of privacy, said Mark Merritt. He's president and CEO of the Pharmaceutical Care Management Assn., which represents the nation's pharmacy benefit managers. For example, the measure would give state attorneys general the ability to enforce federal privacy regulations, he said. That "has the potential to result in myriad civil actions for the same incident and lead to costly and unnecessary litigation expenses for health care providers," Merritt wrote in a Jan. 26 letter to Pelosi.

Any health IT spending should support more than simply making paper records electronic, said Don E. Detmer, MD, president and CEO of the American Medical Informatics Assn., which promotes the effective use of information technology in health care. Such spending also should help physicians adopt clinical decision-making technology and support programs that let patients access their medical records electronically, he said.