Senators John Thune (R-S.D.), Lamar Alexander (R-Tenn.), Pat Roberts (R-Kan.), Richard Burr (R-N.C.), Tom Coburn (R-Okla.), and Mike Enzi (R-Wyo.) today released a white paper, “REBOOT: Re-examining the Strategies Needed to Successfully Adopt Health IT,” outlining concerns with current federal health information technology (health IT) policy, including increased health care costs, lack of momentum toward interoperability, potential waste and abuse, patient privacy, and long-term sustainability.
The 2009 Obama stimulus bill included the Health Information Technology and Economic and Clinical Health (HITECH) Act which aimed to promote the adoption and meaningful use of health IT. Now, nearly four years after the enactment of the HITECH Act, and after hundreds of pages of regulations implementing the program, we see evidence that the program is at risk of not achieving its goals and that $35 billion in taxpayer money is being spent ineffectively in the process.
Findings from the senators’ white paper include:
- Increased Costs. Despite previous estimates that the HITECH Act would save money due to the efficiencies in storing and sharing records and ordering and coordinating patient care, early reports raise concerns that health IT may have actually accelerated the ordering of unnecessary care as well as increased billing.
- Lack of Clear Path Toward Interoperability. The HITECH Act federal incentive payments are being made to hospitals and physicians without clear evidence that providers can achieve “meaningful use,” or the ability to use the health IT program internally, and without an adequate plan to ensure unaffiliated providers can share information with each other through an interoperable network.
- Lack of Oversight. Reports from the HHS Inspector General (IG), the Government Accountability Office, and stakeholders have revealed that the administration does not have adequate mechanisms in place to prevent waste and fraud in its health IT programs. Taxpayer dollars are being paid to providers who cannot or do not have to demonstrate that the health IT technology is actually used as prescribed, because the administration relies on provider “self-attestation” in many cases to determine eligibility for payments.
- Patient Privacy at Risk. The HHS IG found that the security policies and procedures at the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology – two federal entities which oversee the administration of the health IT program – are lax and may jeopardize sensitive patient data.
- Program Sustainability. It is unclear for providers that have accepted grants and incentive payments how much it will cost to maintain their health IT systems after the initial grant money and incentive payments run out. In 2015, incentive payments in most scenarios cease, and providers face reduced Medicare or Medicaid reimbursements if they do not comply with federal requirements, which may impact small providers that may not have economies of scale to make health IT cost-effective.
The white paper is part of a broader effort to solicit feedback from the administration and foster an ongoing conversation on improving the health IT program with the stakeholder community, including health care providers, technology vendors, and others.The full health IT white paper is available here. For a copy of the letter requesting stakeholder feedback by May 16, 2013 on the performance of the health IT meaningful use program, click here, and for a copy of the letter and questions from the senators to HHS Secretary Sebelius, click here. Responses to questions in the letter to HHS are requested by June 16, 2013.