By the Associated Press

President Barack Obama began a week that will dwell heavily on overhauling the healthcare system, declaring himself confident Congress will pass “a good healthcare bill” even though some Republican opponents were trying to kill the measure for political gain.

At the same time, the president and some members of both parties were shifting from hard positions about a government insurance option toward some agreement on reducing medical care costs and restricting insurance company practices

Consensus appeared to be growing on the need to prevent the insurance industry from denying coverage to those with existing medical conditions or canceling policies when a person becomes seriously ill.

A Washington Post-ABC News poll published Monday found the public in a virtual deadlock on the Democrats’ health plan, with 46 percent favoring the proposed changes and 48 percent against them. Americans are also closed divided on whether they should be required to have health coverage, with 51 percent in favor and 47 percent opposed.

The survey was conducted Thursday through Saturday, after the president’s address to Congress, and had a sampling error of plus or minus 3 percentage points.

“I believe that we will have enough votes to pass not just any healthcare bill, but a good healthcare bill that helps the American people, reduces costs, actually over the long-term controls our deficit. I’m confident that we’ve got that,” Obama said in an interview broadcast Sunday on CBS’ “60 Minutes.”

Obama’s spokesman, Robert Gibbs, reiterated that the president prefers the public option, but has said “what’s most important is choice and competition.”

Sen. Olympia Snowe, the Maine Republican who could be the party’s only senator who votes with Democrats, believes choice and competition can be ensured without the public option.

“It’s not on the table. And it won’t be,” she said Sunday. “We’ll be using the co-op as an option at this point, as the means for injecting competition in the process.”

Snowe sits on a six-member panel—three from each party—of the Senate Finance Committee that is writing a version of the healthcare overhaul bill.

Instead of the government running a program that provides low-cost health insurance, Snowe and fellow negotiators are considering a not-for-profit cooperative system. Those backing the measure contend it would substantially lower health insurance premiums by cutting out private-industry profits and guarantee coverage to all who want it.

Such systems exist in some areas of the country but their success has been spotty.

Obama is trying to sweeten the deal for Republicans by indicating he is open to their ideas.

In his Wednesday speech and again in the CBS interview, the president signaled he was open to so-called tort reform. Under current practice, doctors and hospitals must pay huge amounts to insure themselves against malpractice lawsuits by patients seeking large court-ordered settlements for poor treatment.

Democrats, thanks to heavy backing from lawyers, have not supported Republican efforts to limit such payments. Doctors—and Republican politicians—say the current system drives up costs through unneeded medical procedures ordered by physicians who fear being sued.

“I would be willing to … consider any ideas out there that would actually work in terms of reducing costs, improving the quality of patient care,” Obama said in the Sunday interview, which was taped Friday.

While he said he did not back limits on court-ordered rewards for malpractice, he said “there are a range of ideas that are out there, offered by doctors’ organizations like the AMA (American Medical Association), that I think we can explore.”

Gibbs spoke on CNN’s “State of the Union.” Snowe appeared on CBS’ “Face the Nation.”

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$1.2 Billion Slated for HITECH Priority Grant Programs

By News Staff

Nearly $1.2 billion soon will be available to help the nation’s hospitals, physicians and other health care professionals purchase and use electronic health records, or EHRs, according to an Aug. 20 announcement from Vice President Joe Biden. Money from the Health Information Technology for Economic and Clinical Health, or HITECH, Act priority grant programs, which are funded by the American Recovery and Reinvestment Act of 2009, will start flowing in 2010.

“With electronic health records, we are making health care safer, we’re making it more efficient, we’re making you healthier, and we’re saving money along the way,” said Biden in the announcement. “These are four necessities we need for health care in the 21st century.”

The money will be divided between two programs.

• $598 million has been set aside to establish the Health Information Technology Extension Program, which will allow about 70 health IT regional extension centers to offer technical assistance and guidance to support health care professionals using EHRs.
• $564 million will fund the State Health Information Exchange Cooperative Agreement Program, an initiative designed to help states and other entities establish health information exchange capacity among hospitals and health care professionals.

According to David Blumenthal, M.D., M.P.P., the national coordinator for health IT, the rollout of the programs “represents a critical step forward in laying the groundwork for meaningful use of EHRs.”

“Together, the grants will offer much-needed local and regional assistance and technical support to providers while enabling coordination and alignment within and among states, ultimately allowing information to follow patients anywhere within the health care system,” Blumenthal said in an Aug. 20 update e-mailed to health IT stakeholders and posted on the HHS Web site.

Information about the HITECH priority grants program and application requirements is available online from HHS

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By Neil Versel

Vice President Joe Biden, HHS Secretary Kathleen Sebelius and national health IT coordinator Dr. David Blumenthal are in Chicago today to announce $1.2 billion in federal grants to promote EMR use and interoperability. The money represents the bulk of the $2 billion in stimulus funds allocated to the Office of the National Coordinator for Health Information Technology.

Of the $1.2 billion, the administration plans to spend $589 million on health IT extension centers to assist hospitals physician practices in selecting and implementing EMRs. The other $564 million will go to encourage health information exchanges and help build the Nationwide Health Information Network. “Electronic health records can help reduce medical errors, make healthcare more efficient and improve the quality of medical care for all Americans. These grants will help ensure more doctors and hospitals have the tools they need to use this critical technology,” Sebelius says.

The administration officials are speaking at Mount Sinai Hospital, an aging facility in an impoverished West Side neighborhood, where just 7 percent of patients have commercial insurance. Biden is leading a roundtable discussion on comprehensive healthcare reform, focusing, in part, on health IT infrastructure, his office says.

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Funding Comes Courtesy of Federal Stimulus Package

By Sheri Porter

A new report estimates that as many as 45,000 office-based physicians who participate in Medicaid and use electronic health records, or EHRs, could collect as much as $63,750 paid out over a six-year period as part of the American Recovery and Reinvestment Act of 2009.

Notably, about 9,800 primary care physicians — defined by report authors as family physicians, internists and general practitioners — could qualify for the bonuses.

Boosting Health Information Technology in Medicaid: The Potential Effect of the American Recovery and Reinvestment was issued by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, an arm of George Washington University’s School of Public Health and Health Services in Washington.

The report provides insight into federal EHR funding efforts, according to Leighton Ku, Ph.D., M.P.H., professor of health policy at George Washington University and one of four report authors. He said the team wanted to research the little-explored Medicaid payout because it pays significantly more money than the $44,000 maximum provided by a similar Medicare program.

Ku noted that HHS’ bonus payment rules prevent “double dipping” from the Medicare and Medicaid programs. But “If you’re eligible for both (programs),” said Ku, “you’re probably better off taking the Medicaid money.”

HHS is anxious to expedite EHR implementation and is investing $49 billion in the two programs to help ensure that 40 percent of America’s physicians are up to speed with health information technology by 2012.

That goal may be difficult to attain. According to 2006 data from the National Ambulatory Medical Care Survey, only 15 percent of U.S. physicians have fully implemented EHRs; another 16 percent have begun the implementation process, and 69 percent do not use an EHR system.

Medicaid Bonus Criteria

To receive the Medicaid bonus, physicians must meet criteria beyond using a certified EHR. For example, to qualify for the full bonus, at least 30 percent of a physician’s patient panel must be enrolled in Medicaid.

Physicians who practice in federally qualified health centers or rural health clinics have less stringent criteria — they need only claim that 30 percent of their patients are “needy individuals.” As such, the patients must be covered by Medicaid, provided with free care or billed on a sliding-fee scale.

The authors point out that “after-the-fact debt forgiveness is not sufficient to classify a provider as one who serves ‘needy’ patient who are uncovered by Medicaid.”

Also of note, eligible Medicaid physicians will be able to collect $21,250 at the program’s start in 2011 to cover the cost of purchasing or upgrading health information technology, including training and other support services. Physicians who demonstrate “meaningful use” can earn an additional $8,500 annually for the subsequent five years.

The definition of meaningful use is under discussion and should be finalized by year’s end.

On the other hand, the Medicare bonus program rewards early EHR adopters, but it then grants smaller incentive payouts each year ands imposes penalties on physicians who don’t implement a certified EHR by the end of 2015.

High Percentage of Health Centers Qualify

Researchers also determined that a good number of the nation’s community health centers would qualify for the EHR payments because they serve so many low-income patients. They found that in 39 states, 100 percent of health centers would qualify for EHR bonuses, as would 90 percent of community health centers in most of the remaining states.

Ku said that family physicians’ commitment to staffing the nation’s community health centers would add many thousands more FPs to the ranks of physicians eligible for EHR bonuses. “Without family physicians, the nation’s community health centers just couldn’t operate,” he said.

Challenges to EHR Implementation

According to the report, the federal government faces serious challenges if it is to achieve widespread EHR implementation by America’s physicians. To succeed, the government must

• define the term “meaningful use,”
• achieve interoperability that allows for sharing of health records,
• brainstorm ways to finance health information technology over the long term,
• encourage states to rapidly pursue implementation of the Medicaid provisions, and
• find methods to support physicians who don’t qualify under the Medicare and Medicaid bonus programs.

Ku said the federal government is headed in the right direction with the EHR bonus programs. However, he added, lawmakers never expected the health IT subsidies to cover the full cost of purchasing and maintaining physicians’ EHRs. He drew a parallel between HHS’ health IT bonus programs and Washington’s highly publicized “cash for clunkers” automobile buy-back program.

The money available to consumers “won’t buy a whole new car, but it goes a long way toward making the purchase affordable,” he said.

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government-medicine/20090810medicaid-ehr-bonus.html

By Joseph Conn

There may soon be one more incentive for hospitals and physician offices to buy and install electronic health-record systems on or before 2011. The added push could come from the prospect of increasingly higher thresholds of initial federal eligibility requirements for EHR subsidies under the American Recovery and Reinvestment Act of 2009, according to discussions at today’s meeting of the Health Information Technology Policy Committee.

A work group of that committee delivered its first draft of recommended definitions of “meaningful use” of EHRs, a standard that providers must meet to qualify for subsidy payments estimated at $34 billion to be handed out by Medicare and Medicaid. The work group recommended instituting a series of increasingly complex meaningful-use requirements between 2011, the first “payment year” of the subsidy program, and 2015, the final year payments will be made before financial penalties for not adopting begin.

During those discussions, Anthony Trenkle, director of the CMS’ office of e-Health Standards and Services, said the requirements will not be “tiered” based on when the provider adopts an EHR after 2011. Instead, whatever meaningful use standards are applicable for the year the provider applies for an EHR subsidy are the standards that provider must meet, regardless of whether it is the provider’s first year of EHR implementation.

A 10-day public comment period opens today on the work group’s initial recommendations. Trenkle said the CMS hopes to have a final definition of “meaningful use” to put out for a 60-day comment period later this year, with final rulemaking not expected until early next year.

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