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Chairman Deal Urges Caution on Health Care IT Legislation This Year

MARCH 16, 2006 -- House Energy and Commerce Health Subcommittee Chairman Nathan Deal, R-Ga., raised eyebrows Thursday when he said he intends to move cautiously on health information technology legislation this year, outlining plans for a series of hearings on the issue. But Deal's statements aren't a signal he won't move such legislation, a spokesman said.

The Senate has already passed health care IT legislation (S 1418) in the current session of Congress, and Deal has reached agreement on a bill (HR 4157) in the House with the chamber's other key subcommittee chair on the issue, Rep. Nancy L. Johnson, R-Conn., of the Ways and Means Health Subcommittee. In addition, promoting information technology enjoys strong bipartisan support in the House, all of which suggests "IT" is one health care issue on which Congress appears poised to act this year.

But Deal said his subcommittee will consider a variety of bills introduced on health care IT. In addressing the issue, Congress must avoid interfering with private sector progress toward implementing IT and reject an overly regulatory approach to the field, he said in a hearing by his subcommittee.

An Energy and Commerce Committee spokesman said Deal is committed to moving a "meaningful" health care IT bill this year, adding that it won't be the Deal-Johnson bill "word for word."

Concern over the privacy of individual medical records is one of the issues that may be prompting Deal to look beyond his own bill. Privacy advocates have voiced strong objections to a measure in the Deal-Johnson bill that could eventually end state privacy laws that are stronger than the standards adopted by HHS under the Health Insurance Portability and Accountability Act.

Democrats at Thursday's hearing picked up on that concern. Rep. Henry A. Waxman, D-Calif., like Deal, called for "caution" in moving IT legislation, saying that preserving state laws to protect medical privacy should be a "bedrock principle." Michigan Democrat John D. Dingell, the ranking member of the panel, said in a written statement that "over the past week one of the biggest security breaches occurred when PIN numbers for many top banks in the world were compromised. Yet loss of money does not compare to the irreparable damage that can result from sensitive health information, such as mental illness records, HIV/AIDS status, or genetic medical histories being compromised."

At least one privacy group is trying to enlist conservatives in its opposition to the Senate bill and the Deal-Johnson bill. Deborah Peel, a psychiatrist who heads Patient Privacy Rights, said the public lost the right to control its medical records under HIPAA and a national system of electronic access to health care records would dramatically increase that loss of privacy. Companies inevitably will gain access to sensitive personal data leading to denial of employment, Peel said.

Peel said groups ranging from the American Civil Liberties Union to the Christian Coalition share her concern over the lack of sufficient privacy protections in current legislation.

But Deal also must address the concerns of the health care industry, whose representatives voiced concern Thursday that varying state laws would undermine the efficiency of a national health data network. Mark Neaman, CEO of Evanston Northwestern Healthcare system in Evanston, Ill., said that a national system would not be "viable" without a uniform federal privacy standard. Neaman was speaking on behalf of the Healthcare Leadership Council, which represents the biggest companies in health care.

Neaman asserted that medical records would actually be better protected under an electronic system because it would track who had access to electronic records and allow for the criminal prosecution of privacy violators. Paper records are much less tightly controlled, he said.

The Deal-Johnson bill also drew criticism from Consumers Union for its language easing federal anti-kickback legislation. The intent of the provision is to allow insurance companies and hospitals to donate information technology to doctors' practices without being prosecuted for illegally inducing referrals of patients or recruitment of enrollees.

Such donations "will result in distortions of medical treatment and referral patterns, Consumers Union spokesman William Vaughan said in written testimony. "Those donating hardware and software will expect to recover their investment through increased referrals. The history of prescription drug donations and other small 'gifts' to providers shows how such policies promote the overutilization of expensive goods," he said.

Vaughan urged that Medicare payments to doctors who invest in IT be temporarily increased to help them pay for it. Those payments could later be lowered because of the efficiency gains of IT, with a "budget-neutral" effect on Medicare spending, he said.

The Senate bill would not create uniform federal privacy standards, nor would it ease anti-kickback law.

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