As I noted in yesterday's blog, the House of Representatives soon will be taking up a massive economic stimulus package.
I am still making my way through the massive proposal. (It takes awhile to digest $850 billion in new federal spending!) My initial reaction is positive, in that the proposal would fund some of ACP's top priorities: making health information technology more available to clinicians; training more primary care doctors; funding comparative effectiveness; ramping up the overall federal investment in health sciences research; and helping states maintain Medicaid coverage.
Still, I have some early questions:
Will the money on health information technology be spent wisely?
There are skeptics. Charlie Baker writes in the Health Care blog that HIT hardly meets the definition of "shovel-ready:"
"To put this in 'shovel ready' terms, if someone decides to put a new kitchen in their house, or a new bathroom, or a new bedroom, they usually put together plans that outline their end game before they begin. States that build roads, or renovate schools do the same thing. Plans, drawings, blueprints - call them what you will - but they lay out, in advance, how the goals and aspirations of each project are supposed to be achieved. Putting billions into Health IT without putting the plans together first - which is, in fact, what health care reform is all about - seems exactly backward to me."
ACP, in its own letter to HHS nominee Daschle, urged that HIT funding be prioritized and distributed to support applications that will help physicians achieve the capabilities to provide patient-centered care through a medical home.
Will the funding for primary care training result in Congress declaring victory - when there is so much more that will need to be done?
It is good to see that the bill proposes to spend $600 million to train more primary care clinicians through the National Health Services Corps (although it's not clear how much of this will go to physicians versus other professions). By itself, though, expanding the NHSC will not be enough to address a primary care workforce crisis that is spinning out of control. Just last week, the Institute of Medicine reported that 16,261 additional primary care physicians are now needed to meet the demand in currently underserved areas.
To be clear, I think it is good thing that the stimulus bill recognizes the importance of primary care and health information technology. And the provisions to help states maintain their safety net programs and to assist people who may lose health insurance are essential.
I also think though that the HIT funding needs to be targeted to do the most good. And a heckuva lot more is needed to save primary care - including raising primary care payments so they are competitive with other specialties.
Today's questions: Do you support the priorities in the stimulus bill? Would you spend the money differently or better?