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More Than One Approach Suggested to Make Health IT Work for Small Providers

By Mary Agnes Carey, CQ HealthBeat Associate Editor

March 28, 2007 -- A multi-faceted strategy of federal grants, tax credits, loans and additional Medicare payments could be the ticket to enticing physicians and other health care providers to adopt and use health information technology, witnesses and lawmakers said at a House hearing Wednesday.

"We believe it is absolutely essential for Congress, as a first step, to begin to offer targeted financial assistance programs to fund (health information technology) in solo and small medical practices," American College of Physicians President Lynne M. Kirk told the House Small Business Subcommittee on Regulation, Health Care, and Trade.

Few physician practices can afford the costs of installing and maintaining the technology, Kirk said, citing a 2006 review by the Robert Wood Johnson Foundation that found only between 13 percent and 16 percent of solo practitioners were able to adopt health IT. Aside from cost, one obstacle to physician adoption stems from concerns that systems will be quickly outmoded. Another concern revolves around protecting patients' privacy and determining who should have access to the data, witnesses said.

Subcommittee Chairman Charlie Gonzalez, D-Texas, said he plans to reintroduce legislation he sponsored in the 109th Congress that would provide tax incentives, grants and subsidized loans to help small health care providers install and maintain health IT as part of their practices.

Electronic records house a patient's medical history, including past diagnoses, allergies and medications, allowing providers and patients to easily access the information. Proponents of health IT say it could improve the quality of medical care delivered and save the health care system billions.

Gonzalez said his measure would help defray start-up costs of purchasing and installing an electronic health records system, which he said can cost more than $32,000 per physician, with maintenance exceeding $1,200 per month. Kirk said depending on the size of the practice and its applications, acquisition costs on average are $44,000 per physician and the average annual ongoing costs are about $8,500 per physician.

Gonzalez said that without changes in the way health IT is promoted, "small physician practices will be left behind the technological curve and as a result, patients will fail to benefit from the quality of care electronic health records provide."

While health IT legislation has bipartisan support in both chambers, it could be pushed aside this year as other legislative priorities—such as reauthorization of the State Children's Health Insurance Program (SCHIP) or finding a way to prevent a scheduled 10 percent reduction in Medicare physician payments—dominates lawmakers and staff attention, congressional aides said at a March 26 forum. Gonzalez said Congress must move forward "to at least start the government encouragement for adoption of health IT . . . We can't continue to wait."

But the government should make sure the assistance provided does not complicate matters, said the panel's ranking Republican, Lynn Westmoreland of Georgia.

"Remember when the government gets involved in stuff it tends to screw it up," Westmoreland said to chuckles in the hearing room. "When we think we're helping you sometimes we're not."

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