Time for Straight Talk on Technology

Published October 1, 2006

We need to talk about health information technology this month.

On August 22–the same day President George W. Bush signed an executive order promoting price transparency in federal health programs–I took part in a conference call with the White House. Since then I’ve been doing a lot of reading on the topic and talking to a lot of people.

At the risk of making the White House mad at me, I’m gravely concerned about what they’re doing. I don’t think the answer is to bypass the deliberative process when we are talking about something as important as the infrastructure of the entire health care system. This article is my attempt to get some deliberation in before we get into real trouble.

The Executive Order

Most of the PR around this order has focused on price transparency. But that is only one aspect of it, and not even the most substantial.

The executive order primarily addresses health information technology. Every federal agency and federal health care program–Medicare, Indian Health Services, TriCare, and the Veterans Administration–and every provider and health plan that contracts with those agencies will be required to use “health information technology systems that meet recognized interoperability standards.”

Each agency shall also “implement programs measuring the quality of services supplied by health care providers” based on “standards established by multi-stakeholder entities identified by the Secretary [of Health and Human Services],” according to the order. Each agency shall then develop “approaches that encourage and facilitate the provision and receipt of high-quality and efficient health care.”

The Takeover

Price transparency is one thing. That can be satisfied simply by publishing what the feds pay for specific services. That empowers consumers to make better decisions about how to spend their money.

But all this health information technology and quality control is something else entirely. Here the federal government is saying it will determine what technology systems will be used by every hospital, doctor, and insurance company that deals with the federal government. And it will use that technology to measure providers’ “quality and efficiency,” and will develop payment systems that reward those who comply with federally determined standards and punish those who don’t. Those standards will be set by “multi-stakeholder entities.”

I’m not sure how a “multi-stakeholder entity” differs from a regular “stakeholder,” but either way, this is a euphemism for the health care establishment that has made such a hash of things already: the big hospital chains, insurance companies, equipment suppliers, etc.

This has nothing to do with consumer empowerment–quite the opposite. It will further discourage consumers from making decisions that vary from what the academic elite has determined is “good for you.” The order acknowledges this by exempting from the pay-for-performance type of “quality promotion” those agencies that “make available to beneficiaries or enrollees consumer-directed health care insurance products.”

The Reactions

Media reaction has been mixed. The St. Paul Pioneer-Press ran a pretty straightforward story by Jeremy Olson and Rachel Stassen-Berger on August 23 about the event in Minnetonka, Minnesota where Bush signed the order. The president certainly hit the right points, saying, “Health care policy ought to be aimed at bolstering the consumer–empowering individuals to be responsible for health care decisions.”

The story cites some Democrats complaining the order doesn’t do anything to “help the millions of uninsured get health care.” That is a very strange complaint, since this particular action had nothing to do with the uninsured … and when Bush has proposed things that will help, such as refundable tax credits, they’ve complained about that, too.

The August 23 Los Angeles Times story by James Gerstenzang was also straight news reporting, but it included reactions from the “health care establishment” I mentioned above.

Karen Ignani, president of America’s Health Insurance Plans (AHIP), is quoted as saying the order “rewards the delivery of high-quality care, fosters an interoperable healthcare system, and takes steps to ensure that consumers are equipped with the best available information they need to make healthcare decisions.”

I find her comment interesting, because earlier in the article, Bush is quoted as saying that by making consumers more aware of the costs of care, “the government could counter a phenomenon in which [the patient] did not care about the cost because a third party is paying for it.” Is Ignani interested in moving away from third-party payment, or does she see Bush’s order as a way of injecting consumer awareness without changing the underlying economics of third-party payment?

The Future

Some articles about the executive order were more substantive. InformationWeek staff writer Marianne Kolbasuk McGee reported on August 22, “two years ago [Bush] set out the goal for most Americans to have electronic health records by 2014 [but] progress has been slow.” In fact, at that time the president appointed Dr. David Brailer as “health information technology coordinator” but Brailer resigned after two years. Five months later, a replacement still has not been named.

McGee also noted private-practice doctors aren’t likely to be affected by the order, and that they will be reluctant to invest in new technology that benefits payers more than it benefits them.

Meanwhile, the Washington Post ran an article painting a dismal picture of the government’s ability to stay on top of all this data. Due to a “data processing error” on August 23, 1,000 Medicare beneficiaries were wrongly refunded “several months’ worth of premiums they had paid for prescription drug coverage,” and many more were told their premiums will no longer be deducted from their Social Security checks.

The glitches affected less than 1 percent of enrollees … but when the government errs, the effect is huge.

Greg Scandlen ([email protected]) is president of Consumers for Health Care Choices in Hagerstown, Maryland.

For more information …

The text of President George W. Bush’s August 22, 2006 Executive Order: Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs, is available online at http://www.whitehouse.gov/news/releases/2006/08/20060822-2.html

“Bush advocates health-care choice,” by Jeremy Olson and Rachel E. Stassen-Berger, St. Paul Pioneer-Press, August 23, 2006, http://www.duluthsuperior.com/mld/duluthsuperior/15339182.htm

“Bush Order Targets Health Costs,” by James Gerstenzang, Los Angeles Times, August 23, 2006, http://www.latimes.com/news/nationworld/nation/la-na-bush23aug23,0,3464526.story?coll=la-home-nation

“Bush Executive Order Unlikely To Pump Much Life Into Health IT,” by Marianne Kolbasuk McGee, InformationWeek, August 22, 2006, http://www.informationweek.com/shared/printableArticle.jhtml?articleID=192203175