Health information technology is set to receive a $19 billion slice of the American Recovery and Reinvestment Act pie—the stimulus bill President Barack Obama signed in February.
The funds will consist of grants and loans for infrastructure and incentive payments under Medicare and Medicaid to providers who adopt and use health information technology in a “meaningful way.” Those who don’t will see significant reductions in Medicare payments beginning in 2015.
The new federal guidelines define health information technology as “hardware, software, integrated technologies and related licenses, intellectual property, upgrades, and packaged solutions sold as services that are specifically designed for use by health care entities for the electronic creation, maintenance, or exchange of health information.”
“Meaningful use” of that technology is defined as hospitals and physicians using electronic health record systems according to processes being developed in conjunction with the National Institute of Standards and Technology. These include information exchange, use of certified technology, and reporting of certain quality measures where applicable.
Observers of the process are wary of the government’s plans and procedures.
“I think having the federal government set standards and impose punishments is misguided,” said Greg Scandlen, a senior fellow at The Heartland Institute and director of Consumers for Health Care Choices.
“There is currently an explosion of innovation in health IT underway. We do not yet know the best approach and should not dictate a single standard,” Scandlen said. “Locking in a federal standard in 2009 means that innovation will come to a screeching halt.”
Dr. Roger Stark, a health care policy analyst with the Washington Policy Center, notes that in virtually every other economic area where information technology is used, the market sorts out what works best and what consumers want most.
“In this health IT area, however, the government will be telling the consumer—both patient and provider—what the state wants to use,” Stark said. “The government will then force everyone to use their system by decreasing or withholding reimbursements to nonusers. It is laughable to believe the state will come up with a system that is more efficient and cost-effective than the private market.”
Costs Outweigh Benefits
While there is little disagreement that implementation of health IT will produce efficiencies and savings, many argue the costs of federally mandated implementation—in terms of money and autonomy—will outweigh the benefits.
“Proponents say the expansion of computerized information technology in the health care industry is long overdue, but that implies it’s easy and also that it is best done by the federal government,” said Amy Ridenour, president and chairman of The National Center for Public Policy Research. “Most likely, billions of tax dollars will be wasted and the end result will be no truly workable, reliable, private, or useful system.”
“This is being advertised as a huge cost saver,” Stark said. “But health IT will provide virtually no economic stimulus, especially in the near term. It has no business being in the bill.”
Health IT provisions in the stimulus measure also transfer considerable authority from providers to the government in terms of identifying and applying best practices.
“Once everyone is signed up and on board with the government program, it is a small step to then control not only reimbursements but practice patterns as well,” warned Stark. “Health IT is one of the Trojan horses in the Porkulus Bill. Fundamentally, it is a huge intrusion of government into our health care system.”
Dr. Mark Schiller, a senior fellow in medical studies at the University of California-San Francisco and a fellow at the Pacific Research Institute, agrees.
“The health IT provisions in the stimulus bill have nothing to do with improving health care and everything to do with government’s desire to control every aspect of health care,” said Schiller. “It is an abomination that these provisions should be quietly hidden without debate in this massive stimulus bill having nothing whatsoever to do with stimulating the economy.”
Brien Farley ([email protected]) writes from Genesee, Wisconsin.