Three Things Different About Stark’s HIT Bill

Kathryn Mackenzie, for HealthLeaders Media, September 23, 2008

Less than two weeks before the end of the Congressional session, House Ways and Means Health Subcommittee Chair Pete Stark (D-CA) has introduced a bill meant to encourage nationwide adoption of electronic health records. Though the bill builds on the proposed PRO(TECH)T Act, introduced earlier this year by the Energy and Commerce Committee and already under House consideration, it differs in three significant areas, says Robert Tennant, senior policy advisor at the Medical Group Management Association's government affairs office in Washington, D.C.

1. Financial incentives
The bill calls for Medicare payment reductions should the provider not move to an EHR by 2016. In its current state the bill doesn't specify the amount of the proposed penalties, but Tennant says he expects the number will be firmed up in the regulatory phase. Conversely, doctors who choose to use an approved EHR system would be eligible for up to $40,000 over five years in Medicare incentive payments. Hospitals could receive several million dollars in incentives. "The other bills out there don't have near the type of financial incentives as this one. We don't like to see payments be reduced, but we do like incentives, so we'll see what happens. It's a bit of stick and carrot approach," says Tennant.

So, which is more effective—the carrot or stick? Tennant says that will be hard to gauge. "These systems are far more complicated to integrate into a practice than just buying a CD and installing it. It changes the entire workflow, how medicine is practiced, and how the business is operated. It takes years to go from the starting process to full implementation. There has got to be some recognition that it is not as easy as some folks believe it to be," he says. Far more effective and enticing to providers than incentives or penalties, he says would be an open source framework with a single set of standards that can be made available to all providers. This brings us to the second main difference in Stark's Health-e Information Technology Act of 2008 compared to the PRO(TECH)T Act.

2. Open source system
The HIT calls for the creation of a low-cost public IT system for those providers who do not want to invest in a proprietary one. "Basically it means they will take an existing software program and massage it and modify it and make that available to providers," says Tennant. That's the good news, he says. But the challenge is that this has already been tried before, with the Department of Veterans Affairs' VistA system. "We've moved in that direction before, we had a group of vendors working on the VistA office, and we never heard much from it," he says.

Tennant says he is skeptical that the government can come up with something that is low cost yet highly effective and would be able to be integrated with other types of HIT. "Something that doesn't work, or doesn't meet all the privacy and security needs of the people using it, is not worth it."

3. Privacy
The PRO(TECH)T Act requires that providers keep an account of all disclosures of patient data, and obtain permission from the patient each time his or her personal information is going to be accessed for "healthcare operations." Tennant says those requirements place undue burden on providers. "From talking to our members, I understand that in many cases these data are housed in different systems, so if a patient says I want an accounting of all my disclosures, can you imagine the logistics of collecting all this information?" he says. Stark's Health-e Information Technology Act would require the same accounting system, but would loosen some of the regulations by allowing the Department of Health and Human Services Secretary to determine which disclosures would need patient authorization. "The Stark legislation is certainly better language than the Energy and Commerce Committee, but it's still not perfect. These types of disclosures could serve as disincentives themselves. Why would a provider go through all the extra cost and work involved in adopting this technology if it's just going to add more of a burden?" he says.

Tennant points out, however, that MGMA is "pleased that Stark and others have taken great interest in HIT. It's one of very few issues you can actually get bipartisan support on." And while he says he and other stakeholders are excited that the nation may actually be making some tangible steps forward toward wide adoption of EHRs, HIT has had bipartisan support for years, and nothing has been passed yet.

Apparently, even when both sides agree, getting legislation passed is still difficult. But, in a statement introducing the bill, Stark sounded pretty darn adamant about getting something done this time around. "If we want a uniform, interoperable healthcare system in America, time has shown us that we can't depend on the private sector to do it on their own," he said. "This is the perfect role for government. We should work with stakeholders to develop the standards, ensure an affordable product is available and pay providers to adopt it. That's exactly what the Health-e Information Technology Act does."

Time will tell.

Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at
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