In past items, my colleague John and I have weighed in on the issue of whether a change of administration could endanger the Meaningful Use program. We concluded, in summary, that the program has too much momentum to fall to the budget axe that easily.
Now, in the light of an article by a colleague, I’m rethinking my view a bit. In an excellent column for Health Data Management, Joseph Goedert suggests that the so-called “fiscal cliff” has changed everything for the Meaningful Use program. Though the still-sitting president who backed HITECH’s $20 billion spend stayed in office, the House of Representatives remains controlled by the opposition party.
Goedert argues that during the debate over the fiscal cliff negotiations, someone’s going to look at the fat, juicy $20 billion allocated to health information technology — probably the Republicans who have already slammed the program publicly — and target it for budget cutting. He argues that Democrats are unlikely to push back too hard, given that HITECH is hardly a “sacred cow” that legislators fear to touch.
And then, he says, comes a disaster for the health IT community: “Whatever federal funds are left to support electronic health records, meaningful use, health I.T. workforce training, health information exchanges, best practices dissemination, regional extension centers and anything else in the HITECH Act will be gone.”
In Goedert’s view, the only way to save HITECH is for individual physicians hospitals to go on a lobbying tear, pounding their representatives and senators, if they don’t want to see Meaningful Use become a casualty of party politics.
I think Goedert has a point. As he reminds us, eight Republican leaders in the House and Senate finance and health committees have already demanded proof that Meaningful Use is worth the money. And a recent House hearing held to investigate the subject suggests that some members still aren’t satisfied. Things could get ugly.
Actually, wouldn’t ending the MU program now be fiscally irresponsible from a government perspective? The numbers I have seen are that the money that Medicare will recover via penalties for not being in compliance with MU will far exceed what will be paid out in bonuses. However, if Medicare continues on their planned course to largely end fee-for-service payment mechanisms, the penalties may never materialize. Perhaps the penalties may be the final straws ending the system as we currently know it?
Interesting comments Randall. Plus, the disruption of every EHR vendor which has swarmed over MU would get a ton of backlash. I do think the penalties will be delayed, but we’ll see. Depends on how many doctors get on the MU bandwagon and how many would suffer the penalties.
If the penalties for not meeting MU are not delayed or forgiven, there certainly is going to be severe consequences with patients not being able to find clinicians willing to treat Medicare/Medicaid. The majority of clinicians are not participating in MU, and are not likely to be able to absorb the penalties. Penalties will likely trigger a mass exodus of physicians out of these programs. However, other signs are that MU may not be a choice much longer – http://www.emrandhipaa.com/emr-and-hipaa/2010/11/30/meaningful-use-doctors-have-no-choice/
Something has got to give here. In the meantime, I certainly want to support initiatives to more painlessly meet these initiatives.
I grudgingly agree that the stimulus for buying EHRs is good for the industry, although I doubt that most of the products can support the functions that MU requires. The providers will learn as they go along and hopefully they won’t be trapped by their vendors in EHRs without interoperability and good record-keeping practices. But frankly, I would be more disturbed by losing the Center for Medicare and Medicaid Innovation and the cost savings it can produce than losing the EHR incentives.