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The Fiscal Cliff and Meaningful Use: Be Very Afraid

During the congressional tax/budget debate coming very soon, someone in the Republican Party is going to demand another $20 billion or so cut from an entitlement program or another government program that is near and dear to the Democratic Party. Someone in the Republican Party will mention that boondoggle health information technology initiative in the hated stimulus bill, and someone in the Democratic Party will decide that’s where another $20 billion in savings can come from. 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.

Don’t believe all the talk of how health I.T. has bi-partisan support. Nothing but the most sacred cows will be considered sacred in the upcoming budget battle. Since health I.T. doesn’t pass the sacred test, the spigot is in danger of running dry unless the nation’s physicians and hospitals rise up en masse and scare the hell out of their congressional representatives and senators.

Yes, AMA, you have to stop whining about ICD-10 and focus elsewhere on the real here and now. Yes, AHA, all of your hospitals are spending millions of dollars on EHRs and soon won’t be getting those rebate checks, unless you also turn them loose to fight for what they were promised. Yes, insurers and employers, if you want to have any government funding for information systems that will support bending the cost curve and moving to payment models better than fee-for-service, you also have a lot of work to do. And you all need to do it now.

Don’t count on consumers to take the field for meaningful use and anything else reform-related. Half of consumers bought the malarkey that health reform was socialized medicine, if not communist medicine, and either way it would kill Grandma. And consumers simply don’t have the pull that providers, insurers and companies do. The elections are over, so consumer (i.e., voter) influence just dissipated and won’t manifest again until the mid-term elections.

It is the individual physicians and hospitals that must lead the fight--lobbying their representatives and senators extensively--if they want meaningful use to survive. Their associations might decide they have bigger problems to solve, such as mitigating Medicare and Medicaid reimbursement cuts and getting the RAC program revamped into something resembling fairness, and not fight so hard on meaningful use.

Remember, eight Republican leaders in the House and Senate finance and health committees are pressing the Department of Health and Human Services to prove the meaningful use program is of merit and not just a way for docs to use EHRs to overbill Medicare. And that’s not all; Republicans in the House Science and Technology Committee question the value of meaningful use; counterparts in the House Small Business Committee question the safety of EHRs. And the Democrats have been utterly silent. So, the GOP needs educating and the Dems need pushing.

Here’s what you face in the fiscal cliff fight: The industry--and those critical funding programs--are up against Democrats who don’t want to face reality, and Republicans who don’t know what reality is and don’t care to learn.  Think the election changed anything on the House and Senate floors? Think again. Democrats don’t have any more power than they did before, but may think they have a mandate--which they don’t necessarily have--and won’t make the compromises necessary to get the fiscal house in order. With few exceptions, Republicans are in denial of their Electoral College wipeout and are doubling down on their hatred of all things President Obama. They can’t wait to get their hands on reform-related spending when the fiscal cliff negotiations gear up.

It is the holidays and legislators don’t want to spend the next six weeks in Washington. They will play their games until leadership can reach a deal and hit the airport, and history has shown last-minute horse trading can do an amazing amount of damage to existing and anticipated appropriations. What you want has got to be protected in that deal. Time to get to work.

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