Within the next day or so, Congress is expected to give final approval to the stimulus bill. I have not yet seen the final language that House and Senate negotiators signed off on yesterday, but it appears likely that it will include three of ACP's top priorities: funding for health information technology, training of more primary care clinicians, and research on comparative effectiveness.
Some ACP members, though, have told me that they are concerned - as one long-time ACP member in California described it - that the bill will "allow the government to track everything we do for our patients and dictate the care we provide." The source of his information was a widely-circulated commentary by Betsy McCaughey, a fellow with the Hudson Institute and a former lieutenant governor for New York State.
Ms. McCaughey says that "Your medical treatments will be tracked electronically by a federal system ... One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective [which] would allow the government to track the care that doctors provide to patients."
The legislation codifies the role of the National Coordinator of Health Information Technology (which, by the way, was created by the Bush administration). The National Coordinator has absolutely no authority to require that physicians submit treatment data to the federal government. Instead, it will work with the private sector to make sure that electronic health records (EHRs) meet standards of usefulness and interoperability - something most physicians and patients should welcome.
The bill also gives physicians the opportunity to apply for Medicare payment subsidies - as much as $40,000 per physician - to help them buy a certified EHR. If a physician chooses to accept the incentives (it is voluntary, after all), he or she will have to agree to use the technology for meaningful uses that will improve patient care and provide some documentation that this really is the case. Meaningful purposes will be defined in more detail later on, but will be things like using the EHR to generate reminders that a patient is due for preventive screening, or making it possible for physicians to electronically participate in quality measurement and reporting programs. This in turn will create market incentives for EHR manufacturers to make sure that their systems actually have the capabilities needed to support such "meaningful purposes" that contribute to better patient care.
Think about it this way. Would you want taxpayers to subsidize EHR systems that don't have the functions needed to help clinicians make meaningful improvements in patient care? Why would physicians want to buy such systems? And what physician wouldn't want to use their EHRs to making meaningful improvements in patient care, as long as the EHR has the necessary capabilities?
It is true that physicians will eventually be subjected to Medicare payment cuts if they don't have a certified EHR. ACP has expressed concern about the penalties, and will work to assure that a number of pre-conditions are met - like true interoperability, affordability and functionality of EHRs - before any penalties could go into effect.
Finally, there is nothing in the legislation that gives the federal government the authority to mandate plans of care. The funding for comparative effectiveness research will go to two well-respected research entities, the National Institutes of Health and the Agency for Healthcare Research and Quality, not some new regulatory super-agency. This is what the Senate Finance Committee has to say:
Q: Can the government use the results of this [comparative effectiveness] research to tell me, or my doctor, what tests and treatments I can or cannot have?
A: Absolutely not. In fact, the Senate bill specifically prohibits the government from making any coverage decisions based on this research, or even from issuing guidelines that would suggest how to interpret the research results. The sole aim is to disseminate the results of the research to the public, so that patients and their doctors can make the best decisions for their specific situations, together.
It is one thing to make a philosophical argument against the government subsidizing things like EHRs, primary care, and comparative effectiveness. It is another thing to make wild exaggerations that have little or no basis in fact.
Today's question: What do you think of Ms. McCaughey's claims and my response to them?