Views Differ on GOP Cost-Cutting Bill

Legislation from House Republicans to cut funding for numerous federal programs--including the electronic health records meaningful use incentive payments--is not going to become law, in the opinion of two health information technology policy professionals. But they have differing views on the long-term importance of the bill.

The legislation is H.R. 408, which seeks to cut $2.5 trillion in federal spending by 2011 (see story). While the bill would cut the $27 billion pegged for incentive payments, it would not repeal the HITECH Act or funds under the act that have been "obligated" to pay for state health information exchanges, regional extension centers, college-level health I.T. curricula and other initiatives, believes Dave Roberts, vice president of government relations at the Healthcare Information and Management Systems Society.

But the bill is causing confusion in the industry and that is a concern, he adds. "A lot of people don't understand the balance of power in Washington and all they hear is that the House is going to take away the incentives."

The bill may well pass the House, but it won't go further, at least not in the near term, according to Roberts. Further, a handful of bill sponsors are long-time advocates of health I.T. and didn't know elimination of incentive payments was part of the legislation. These sponsors, however, could vote for the bill in the House knowing it is only a symbolic vote for lower government spending.

The challenge for the industry is to protect the HITECH programs and meaningful use incentives over the long term, Roberts says. "This is a run-up to the 2012 elections," he explains. "It is a symbol of what could come based on what voters are telling their public officials."

Congress has supported the EHR incentives program as a national priority, but the environment has changed to where half of Congress wants to go down a different path and focus on cutting spending, Roberts says. "Now the debate is turning and people are saying 'We shouldn't put federal funding into this.'"

So, the challenge is to continue to hold support for the incentive funds at the congressional and grassroots levels, because there are at least two other bills being developed in the House that target the incentives for elimination, he adds. "This is a piece of legislation that puts thoughts in people's heads."

On the flip side, H.R. 408 doesn't worry government watcher Justin Barnes in the slightest. "I have zero concern about it taking away the incentives," says the vice president of marketing, corporate development and government affairs at software vendor Greenway Medical Technologies. He's also past leader of the HIMSS Electronic Health Records Association.

The legislation "is a message bill," Barnes says. "It is a campaign promise." Even if the bill were to come to the House floor for a vote, it would not pass in its current shape and health I.T. funds would not be on the cutting block, he contends.

The incentive payments were put in the Medicare Trust Fund so they would not be subject to the whims of the annual appropriations process, Barnes says. Any attempt to eliminate them would require overriding a presidential veto. Further, the payment of incentive funds are front-loaded, with half or more of a provider's total incentives being paid during the first two years.

--Joseph Goedert