Debate Continues Over Use of Stimulus Funds

WASHINGTON — The health care provisions in the federal economic stimulus package continue to spark disagreement between Republicans and Democrats, as seen at a diabetes meeting sponsored by Avalere Health.

Wendell Primus, senior policy adviser to House Speaker Nancy Pelosi (D-Calif.), noted three provisions of interest in the Recovery Act (formally called the American Recovery and Reinvestment Act of 2009): $87 billion in Medicaid funding to states; a 65% subsidy to laid-off workers who are still receiving health coverage from their former employers through COBRA; and $19 billion to be invested in health information technology (HIT).

Under the HIT component of the law, the government must develop certain technology standards, Mr. Primus said.

One important standard is interoperability. “We have an example [of noninteroperability] right here in town,” Mr. Primus noted. “The George Washington [University] Hospital just recently bought an HIT system for its emergency department and one for its inpatient department, and unfortunately those two systems don't talk to one other.”

Functionality is another critical standard. “If I have a doctor-patient relationship, I may know what I think your situation is, but I may not know the four doctors that have seen you since your last visit to me,” Mr. Primus said. “I want [the medical record] to quickly be able to tell the doctor that's currently visiting that patient what has happened, and what the other four doctors have prescribed. We also want the system to be able to do reminders.” The government also must develop standards for data security and for privacy.

The Recovery Act includes incentives of $40,000-$60,0000 for providers to use toward the purchase of an HIT system. Over time, “those incentives turn into penalties” in the form of reduced reimbursement from government health care programs if physicians do not adopt an HIT system, he said. “We're using the sticks of Medicare and Medicaid to make sure we get all doctors' offices wired within 8–10 years.”

From the Republican perspective, Dan Elling, minority staff director on the House Ways and Means subcommittee on health, said some of the HIT provisions were problematic.

“Having hospitals and doctors be able to talk to one another and coordinate care … is going to improve our health care system,” he said. However, “the incentive payments don't start until 2011. If this is part of the stimulus bill and we're not spending the money for another 3 years, what are we doing?”

In addition, “each physician would be able to qualify for up to $64,000 in incentive payments, independent of the actual cost of the system,” said Mr. Elling, whose boss is Rep. Dave Camp (R-Mich.). “So if you're part of a 20-doctor practice that's able to use economies of scale … and purchase an HIT system that costs $20,000 per physician, that doctor is able to pocket the extra $44,000. That's taxpayer money. We'd [prefer] language that says, 'You only get what you pay [out]'” in terms of reimbursement by the government.

Another big chunk of the Recovery Act funds is the $1.1 billion for comparative effectiveness research. CER is designed to let physicians know which treatments are the most clinically effective and the most cost effective, according to Mr. Primus. He said that CER is not “cookbook medicine,” but is aimed at producing “better public knowledge.”

Mr. Elling agreed that “done effectively, there's a lot of promise in CER. Getting more information to patients and physicians is outstanding and we should be doing that.” But he added that it increases government control of health care, especially since the consumer effectiveness board that's called for in the bill comprises only government employees, with no practicing clinicians or patient advocates as members.

WASHINGTON — The health care provisions in the federal economic stimulus package continue to spark disagreement between Republicans and Democrats, as seen at a diabetes meeting sponsored by Avalere Health.

Wendell Primus, senior policy adviser to House Speaker Nancy Pelosi (D-Calif.), noted three provisions of interest in the Recovery Act (formally called the American Recovery and Reinvestment Act of 2009): $87 billion in Medicaid funding to states; a 65% subsidy to laid-off workers who are still receiving health coverage from their former employers through COBRA; and $19 billion to be invested in health information technology (HIT).

Under the HIT component of the law, the government must develop certain technology standards, Mr. Primus said.

One important standard is interoperability. “We have an example [of noninteroperability] right here in town,” Mr. Primus noted. “The George Washington [University] Hospital just recently bought an HIT system for its emergency department and one for its inpatient department, and unfortunately those two systems don't talk to one other.”

Functionality is another critical standard. “If I have a doctor-patient relationship, I may know what I think your situation is, but I may not know the four doctors that have seen you since your last visit to me,” Mr. Primus said. “I want [the medical record] to quickly be able to tell the doctor that's currently visiting that patient what has happened, and what the other four doctors have prescribed. We also want the system to be able to do reminders.” The government also must develop standards for data security and for privacy.

The Recovery Act includes incentives of $40,000-$60,0000 for providers to use toward the purchase of an HIT system. Over time, “those incentives turn into penalties” in the form of reduced reimbursement from government health care programs if physicians do not adopt an HIT system, he said. “We're using the sticks of Medicare and Medicaid to make sure we get all doctors' offices wired within 8–10 years.”

From the Republican perspective, Dan Elling, minority staff director on the House Ways and Means subcommittee on health, said some of the HIT provisions were problematic.

“Having hospitals and doctors be able to talk to one another and coordinate care … is going to improve our health care system,” he said. However, “the incentive payments don't start until 2011. If this is part of the stimulus bill and we're not spending the money for another 3 years, what are we doing?”

In addition, “each physician would be able to qualify for up to $64,000 in incentive payments, independent of the actual cost of the system,” said Mr. Elling, whose boss is Rep. Dave Camp (R-Mich.). “So if you're part of a 20-doctor practice that's able to use economies of scale … and purchase an HIT system that costs $20,000 per physician, that doctor is able to pocket the extra $44,000. That's taxpayer money. We'd [prefer] language that says, 'You only get what you pay [out]'” in terms of reimbursement by the government.

Another big chunk of the Recovery Act funds is the $1.1 billion for comparative effectiveness research. CER is designed to let physicians know which treatments are the most clinically effective and the most cost effective, according to Mr. Primus. He said that CER is not “cookbook medicine,” but is aimed at producing “better public knowledge.”

Mr. Elling agreed that “done effectively, there's a lot of promise in CER. Getting more information to patients and physicians is outstanding and we should be doing that.” But he added that it increases government control of health care, especially since the consumer effectiveness board that's called for in the bill comprises only government employees, with no practicing clinicians or patient advocates as members.

WASHINGTON — The health care provisions in the federal economic stimulus package continue to spark disagreement between Republicans and Democrats, as seen at a diabetes meeting sponsored by Avalere Health.

Wendell Primus, senior policy adviser to House Speaker Nancy Pelosi (D-Calif.), noted three provisions of interest in the Recovery Act (formally called the American Recovery and Reinvestment Act of 2009): $87 billion in Medicaid funding to states; a 65% subsidy to laid-off workers who are still receiving health coverage from their former employers through COBRA; and $19 billion to be invested in health information technology (HIT).

Under the HIT component of the law, the government must develop certain technology standards, Mr. Primus said.

One important standard is interoperability. “We have an example [of noninteroperability] right here in town,” Mr. Primus noted. “The George Washington [University] Hospital just recently bought an HIT system for its emergency department and one for its inpatient department, and unfortunately those two systems don't talk to one other.”

Functionality is another critical standard. “If I have a doctor-patient relationship, I may know what I think your situation is, but I may not know the four doctors that have seen you since your last visit to me,” Mr. Primus said. “I want [the medical record] to quickly be able to tell the doctor that's currently visiting that patient what has happened, and what the other four doctors have prescribed. We also want the system to be able to do reminders.” The government also must develop standards for data security and for privacy.

The Recovery Act includes incentives of $40,000-$60,0000 for providers to use toward the purchase of an HIT system. Over time, “those incentives turn into penalties” in the form of reduced reimbursement from government health care programs if physicians do not adopt an HIT system, he said. “We're using the sticks of Medicare and Medicaid to make sure we get all doctors' offices wired within 8–10 years.”

From the Republican perspective, Dan Elling, minority staff director on the House Ways and Means subcommittee on health, said some of the HIT provisions were problematic.

“Having hospitals and doctors be able to talk to one another and coordinate care … is going to improve our health care system,” he said. However, “the incentive payments don't start until 2011. If this is part of the stimulus bill and we're not spending the money for another 3 years, what are we doing?”

In addition, “each physician would be able to qualify for up to $64,000 in incentive payments, independent of the actual cost of the system,” said Mr. Elling, whose boss is Rep. Dave Camp (R-Mich.). “So if you're part of a 20-doctor practice that's able to use economies of scale … and purchase an HIT system that costs $20,000 per physician, that doctor is able to pocket the extra $44,000. That's taxpayer money. We'd [prefer] language that says, 'You only get what you pay [out]'” in terms of reimbursement by the government.

Another big chunk of the Recovery Act funds is the $1.1 billion for comparative effectiveness research. CER is designed to let physicians know which treatments are the most clinically effective and the most cost effective, according to Mr. Primus. He said that CER is not “cookbook medicine,” but is aimed at producing “better public knowledge.”

Mr. Elling agreed that “done effectively, there's a lot of promise in CER. Getting more information to patients and physicians is outstanding and we should be doing that.” But he added that it increases government control of health care, especially since the consumer effectiveness board that's called for in the bill comprises only government employees, with no practicing clinicians or patient advocates as members.