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Clinton, Gingrich, Other Stars May Be Aligning for Health Care IT Bill

MAY 11, 2005 -- Any health care legislation with the names Kennedy, Gingrich, Clinton—and possibly Frist—listed as supporters is likely to get more than a second glance in Congress, particularly if it's a low-cost way to address a high profile policy issue: health care information technology.

That's why the 21st Century Health Information Act of 2005, HR 2234, is likely to grab a lot of attention in coming weeks. Unveiled Wednesday at a press conference by Reps. Patrick J. Kennedy, D-R.I., former Speaker of the House Newt Gingrich, Sen. Hillary Rodham Clinton, D-N.Y., and Rep. Tim Murphy, R-Pa., the bill aims to upgrade the quality, efficiency, and safety of health care by encouraging adoption of health care information technology through regional networks.

Clinton indicated that she expects the bill, or something similar, to be part of broader Senate legislation she plans to introduce with Senate Majority Leader Bill Frist, R-Tenn., in the next few weeks. Clinton declined to specify what other health provisions the bill would contain other than those pertaining to IT.

A Senate aide confirmed that Frist and Clinton are working on legislation similar to, but broader than, the Murphy-Kennedy bill. That effort also aims to enlist other key Senate GOP leaders as supporters, the aide said.

Kennedy stressed his bill reflects the thinking of a wide variety of people and organizations involved in furthering health care IT, including Dr. David Brailer, National Health Information Technology Coordinator at the Department of Health and Human Services. "I believe his insight is found within the pages of this legislation," Kennedy said.

Gingrich declared the bill "sets the stage for the House and Senate to do something decisive this year."

Without offering an explicit endorsement, HHS Secretary Michael O. Leavitt said the legislation is in line with the policy conversations that need to occur about furthering IT.

His remarks came at an event announcing announced the release of a report by the Lewin Group emphasizing the importance health care IT in maintaining U.S. competitiveness in the global economy. The message is that "message in health IT in urgent," Leavitt said.

The Murphy-Kennedy bill addresses important areas such as interoperability and payment incentives, Leavitt said. Brailer said the administration isn't offering legislation of its own and doesn't endorse any existing bill, but added that "nothing's hard and fast."

The bill names no specific dollar amounts to help pay for IT other than $50 million in fiscal 2006 grants to help regions develop and implement plans for health information technology networks. While it also provides for a program of loans to those networks to acquire IT, it does not specify how much money would be lent out.

And while it provides for Medicare payment "adjustments" to providers and suppliers who take part in the networks, it does not specify how much money would be involved.

Kennedy said many providers will be "disappointed" about the lack of subsidies in the bill. However, he said he hopes Frist's leadership will be able to secure Medicare money as well as federal matching payments to states to design and implement IT programs in their Medicaid programs.

The bill's supporters say it lays a groundwork for efficient investment. It would do so by ensuring that common interoperability standards are adopted to make sure the computer systems making up regional networks allow data and images to flow smoothly.

Under the bill, the Certification Commission for Healthcare Information Technology, an industry group formed to ensure standards, would be required to agree on interoperability standards for electronic health records within nine months of enactment.

If that deadline passes, HHS could adopt its own standards or designate another entity to do so. Networks would have to meet those standards to quality for federal assistance.
A central premise of the legislation is that IT should be adopted through formation of regional health information organizations—RHIOs. That also reflects the view of the Medicare Payment Advisory Commission (MedPAC) and the Bush administration, which sees RHIOs as building blocks for a national network.

In recommendations to Congress, MedPAC stopped short of advising the creation of a large loan program, but said that if one were adopted, it should lend money to community systems that brought in a wide range of providers and payers who planned carefully and put up their own money as well. The community systems would have to have detailed plans to assure privacy and interoperability, MedPAC said.

The $50 million authorization would fund 20 competitive three-year grants to 20 RHIOs. The bill also would authorize "such sums as necessary" for the grant programs for fiscal years 2007–2010. It also would provide $2.5 million each year from fiscal 2007 to 2010 for the creation of a national technical assistance center within the Agency for Healthcare Research and Quality to help doctors' offices make sound IT investments.

HHS would have to certify that networks meet privacy, interoperability, and other standards.

In addition to encouraging standards and regional planning, the bill aims to spur investments by the health care industry. Gingrich said it would encourage hospitals to provide doctor's offices with electronic health record systems by creating an exception to federal legislation barring hospitals from making such donations as a way of inducing referrals.

Gingrich claimed that because of IT's savings potential, hospitals would be willing to outfit up to 80 percent of physicians' offices around the U.S. with electronic health records if they could be assured of not running afoul of federal law on referral inducements.

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