Following the shift to a Republican majority in the U.S. House of Representatives, the pre- and post-election focus of GOP leaders on repealing all or parts of the Patient Protection and Affordable Care Act (PPACA) have led to much discussion and media attention on whether the few true health IT aspects of the Act are in jeopardy, and has even extended speculation – and in some cases confusion – as to whether physician and hospital incentive funds within the government’s previous Meaningful Use initiative are also a target.
There are several foundational elements – and one major point of Meaningful Use funding – that should allay concerns for current and future funding for the adoption of certified electronic health records (EHRs).
Fundamentally it’s important to note that the Health Information Technology for Economic and Clinical Health (HITECH) Act, from which the Meaningful Use program and its funding originates within the American Recovery and Reinvestment Act (ARRA) of 2009, is an entirely different statute than PPACA.
Bipartisan support for the tenets and the spirit of HITECH dates back at least seven years, and it is also noteworthy that the Office of the National Coordinator for Health Information Technology (ONC), which administers Meaningful Use, was created by the Bush administration and a Republican Congress.
Politics aside though, the reason that Meaningful Use funds are secure is because they are drawn from the Medicare Trust Funds held by the U.S. Treasury, and are therefore not subject to annual Congressional budget appropriations or oversight.
In other words, the funding is grounded in law, and has inherent flexibility to encompass the number of ambulatory practices and hospitals seeking Meaningful Use incentives capture. The incentive payments are procured through the Centers for Medicare and Medicaid Services (CMS).
There are, though, health IT provisions within PPACA that merit attention, primarily the planned creation of Accountable Care programs meant to leverage health IT to improve patient safety and promote wellness through best practices and evidence-based medicine.
These aspects of the reform statute, however, have not come under specific concern, and those that have, such as the 1099 provision calling for small businesses to expand IRS reporting of the purchasing of goods and services, has come under the most scrutiny. Meantime, aspects such as eliminating pre-existing conditions toward obtaining insurance have also been largely a bipartisan pursuit. Other aspects coming under scrutiny do not “kick in” until 2014, and overall it is arguable that PPACA is at its heart insurance reform rather than a statute based upon health IT provisions.
Bringing politics back into the discussion, the U.S. Senate and of course the White House remain in Democratic quarters, lessening a broad impact on any of the healthcare Acts being discussed. The White House has signaled a willingness to modify some non-health IT aspects of PPACA, which could lead to a stronger and more secure statute going forward. And following my own time spent in Washington, D.C. just after the elections, there is also a sentiment not to discourage America’s physicians and hospitals already adopting EHRs as well as those planning to do so in time for 2011 Meaningful Use incentives.
The November elections also brought a record of up to 28 new governors to statehouses throughout America, which in theory could impact some state Medicaid processes and procedures concerning the implementation of HITECH plans. But here also the funding, like that for state Health Information Exchange programs, for example, has already begun arriving in state coffers, and there is no fear today of any disruption.
If there are future revisions to PPACA, the consensus is that its health IT provisions are secure, and the goal is that Accountable Care and related aspects will remain intact because they, along with Meaningful Use, play a credible and crucial role in the creation of a smarter, more fiscally sound healthcare system less given to waste, fraud and abuse.
What is clear is that current Meaningful Use funds and those for Stage 2, 3 and beyond remain a safe choice for physicians and hospitals.
Justin Barnes is vice president of marketing, corporate development and government affairs for Greenway Medical Technologies, Inc., and chairman emeritus of the national Electronic Health Record Association (EHRA).