Senators Call for Review of HITECH

Six Republican Senators have formally requested that U.S. Department of Health & Human Services Secretary Kathleen Sebelius provide a written plan to address how the agency is implementing the Health Information Technology for Economic and Clinical Health (HITECH) Act. 

In an April 16 letter—signed by Senators Lamar Alexander (R-Tenn.), Richard Burr (R-N.C.), Tom Coburn (R-Okla.), Mike Enzi (R-Wyo.), Pat Roberts (R-Kan.) and John Thune (R-S.D.)—they state that Congress has an obligation to conduct oversight of government programs. To that end, they released a 28-page white paper entitled “REBOOT: Re-Examining the Strategies Needed to Successfully Adopt Health IT” that outlines their concerns with current health IT policy, including the costs, interoperability, the potential for waste and abuse, patient privacy and sustainability.

The Senators asked that in conjunction with ONC and the Centers for Medicare and Medicaid Services (CMS), the Secretary provide a detailed written plan to address the concerns in the enclosed white paper, to ensure that health IT taxpayer investments today are sound and result in a safe, secure, interoperable health IT system in the future. Specifically, please address your plans to achieve interoperability, control billing costs, prevent waste and abuse, protect patient privacy, and ensure the program is sustainable.  The Senators also asked for answers to the following questions by June 16, 2013: 

1. A list of every contract or task order awarded to perform work related tothe HITECH Act, including the recipient, the amount and length of the contract, and the nature of the work to be performed.
2. An update on ONC’s planned contract with Mathematica Policy Research to build a model to understand the linkages between all of the different health IT programs, as well as the cost and quality implications of health IT, and copies of any findings reported to HHS, ONC or CMS
3. An update of ONC’s contract with the National Opinion Research Center at the University of Chicago (NORC) to conduct an evaluation of state health IT programs as mandated in HITECH and a copy of any findings
4. ONC funded $250,000,000 in cooperative agreements to Beacon Communities that, according to ONC, “have already made inroads in the development of secure, private, and accurate systems of EHR adoption and health information exchange.”  How many of these communities will have to reduce their standards in Stages 2 and 3 to avoid penalty payments?  What work has HHS, ONC,or CMS done to evaluate the progress of each of the Beacon Community awardees and how they will be impacted by Stage 2 and 3 milestones?
5. An update on the status of a contract with the American Institute for Research (AIR) to evaluate the effectiveness of different HIT activities.  The evaluation was to include a survey of providers and regional extension centers (RECs) and capture information such as how the RECs affected EHR adoption in the region.
6. ONC was planning to conduct evaluations of HITECH implementation in three cycles with separate deliverable dates to the National Coordinator on February 1, 2012; April 1, 2012; and September I, 2012. ONC was also expected to produce an overall summary of all three reports.  The Senators asked for copies of all reports delivered by ONC to the National Coordinator and expected dates of publication for unpublished reports.
7. Section 232 of the HITECH Act required the National Coordinator to assess and publish the impact of health IT in communities with health disparities and in areas with a high proportion of individuals who are uninsured, underinsured, and medically underserved (including urban and rural areas), identify practices to increase the adoption of health IT by health care providers in such communities, and assess the use of health IT to reduce and better manage chronic diseases. The Senators asked for an update on the status of this assessment and provide copies of any related findings reported to ONC to date. 

In their white paper, the Senators point out additional concerns.  For example, they note early reports, which suggest that federal incentive payments are being made without clear evidence that providers can achieve “meaningful use,” or the ability to use the health IT program internally, and without an adequate plan to ensure providers can share information with each other.  In addition, they noted that although CBO estimated that HITECH will save Medicare and Medicaid programs about $12.5 billion through 2019, health IT may have actually accelerated the ordering of unnecessary care as well as increased billing for the same procedures. 

The white paper also pointed out reports that “taxpayer dollars being paid to providers who cannot or do not have to demonstrate that the technology is actually used as prescribed, because the administration relies on provider “self-attestation” in many cases to determine eligibility for payments.  In some cases, contractors receiving government funds may be creating obstacles to interoperability.”  In other cases, providers who have previously received federal incentive grants are reportedly now forced to adopt less advanced technologies to meet current standards, effectively forcing them to scrap prior federally subsidized investments. 

Finally, the Senators raised concerns about patient privacy and program sustainability.  For example, HHS-OIG found that the security policies and procedures at the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology – two federal entities that oversee the administration of the health IT program – are lax and may jeopardize sensitive patient data.   

Additionally, “it is unclear how much it will cost to maintain their health IT systems after the initial grant money and incentive payments run out.”  Further, penalties are most likely to affect small providers who may not have the economies of scale needed to make complex electronic systems cost-effective.