Unexpected opposition to EHR incentive program should be watched by pathologists and clinical laboratory managers

Questions about the value of the federal government’s program to encourage provider adoption of electronic health record (EHR) systems were raised by Republican leaders in both houses of Congress just weeks before the election on November 6.

Because clinical laboratories and pathology groups have a big stake in interfacing their laboratory information systems to physicians’ EHRs, this new development bears watching.

In October, GOP Senators and House Republicans joined together and issued a call for an immediate halt to distribution of incentive payments to providers for implementing electronic health record (EHR) systems. This program is now in its second full year of implementation.

GOP Lawmakers Want Tougher Interoperability Standards

Four Republican Senators sent a letter to Health and Human Services (HHS) Secretary Kathleen Sebelius. The Senators cited “weak” EHR interoperability standards under Stage 2 of the HITECH Act and called for temporary suspension of EHR incentive payments.

It was in September when several prominent House Republicans sent a letter to HHS Secretary Kathleen Sebellius that called for several changes in the ongoing federal program to encourage providers to adopt electronic health record systems. Pictured above is Representative Dave Camp (R-Michigan). He is Chairman of the House Ways and Means Committee and was one of those Representatives who signed the letter. (Photo by Pablo Martinez Monsivais and copyright the Associated Press.)

The Senators who signed the letter were John Thune (R-SD), Tom Coburn (R-OK), Richard Burr (R-NC), and Pat Roberts (R-KS) calling These senators all serve on either the Finance or Health, Education, Labor and Pensions (HELP) committee.

Earlier, in September, several House Republicans sent a similar letter to Secretary Sebellius. It was authored by representatives who serve on one or more of the following: the House Ways and Means, the Subcommittee on Health, the Energy and Commerce Committee, or the Subcommittee on Health.

The Republican House leaders wrote that: “Stage 2 rules fail to achieve comprehensive interoperability in a timely manner, leaving our health-care system trapped in information silos, much like it was before the incentive payments.”

Contending “EHR payments are a waste of taxpayer dollars” under Stage 2 rules, the House Republicans called for:

• Stopping all incentive payments until new interoperability rules are created to significantly increase what is expected of “Meaningful Users”;
• Postponing penalties for providers that do not adopt EHR systems;
• Increasing the thresholds for Stage 2 measures; and
• Eliminating subsidization of business practices that block exchange of information between providers.

New York Times Story Suggests EHRs Increase Fraudulent Billings

These members of Congress began questioning HITECH merits following a New York Times article that indicated EHRs may contribute to higher Medicare costs. The report suggested that EHRs contribute to billing fraud because the electronic systems make it easier for hospitals and physicians to upcode more frequently.

Hospitals received $1 billion more in payments in 2010 than five years earlier, in part by changing billing codes, noted the New York Times story. In a similar fashion, physicians changed the way they submitted claims for office visits, which increased payments to them by billions, as well. The New York Times found that aggressive billings by just 1,700 of the nation’s 440,000 physicians cost Medicare $100 billion in 2010 alone.

However, an Op/Ed piece written by Marianne Kolbasuk McGee, Managing Editor of HealthcareInfoSecurity, noted that the link between fraudulent billings and EHRs is unproven. “Suspending the HITECH incentive program midstream…will only fuel uncertainty and distrust among many healthcare providers that have, in good faith, begun adopting EHRs,” she contended.

Health-Care Industry Responds To Criticisms of Federal EHR Program

Not surprisingly, the prospect of suspension of EHR incentives brought criticism from leaders in both the healthcare and informatics industries.

During a session of a Bipartisan Policy Center (BPC) conference, Karen Ignagni, CEO of America’s Health Insurance Plans, said: “The importance of common standards can’t be overstated. We need to be rowing the boat in the same direction.”

Speaking at the same BPC session, Doug Gentile, MD, chief medical officer at Allscripts Healthcare, noted, “We’re in the early stages of one of the fastest transformations of any industry in history. As we make the shift to value-based care, the business case for information sharing becomes front and center.” He pointed out that the policy challenge is to turn “interoperability into an ecosystem for innovation.”

The Healthcare Information and Management Systems Society (HIMSS) issued a press release opposing the premise of the letter. “HIMSS supports the concept of graduated complexity of meaningful use,” stated the release. “This stepped approach recognizes evolutionary maturity of adoption and implementation of health IT,…which serve as the foundation for healthcare transformation. Significant progress has been made; widespread interoperability is within reach.”

Of course, all of this is likely to be political posturing by Congressional Republicans. It is unlikely that any attempt to block EHR incentives would pass the Democratic Senate or be signed by the President. On the other hand, the fact that prominent Republicans in both houses of Congress sent letters to Secretary Sebellius that contained criticisms of the federal EHR incentive program may indicate that more will be said on this issue in coming months. For these reasons, clinical laboratory professionals may want to keep a watchful eye on this development.

—Patricia Kirk

Related Information:

Medicare Bills Rise as Records Turn Electronic

Top House Republicans demand suspension of electronic medical records program

House Republicans Say Meaningful Use Bar Set Low

Senate Republicans Send Letter to Sebelius with Concerns over Meaningful Use

Industry Responds to GOP Letter Stating Cease EHR Incentives