Congress Should Repeal the HITECH Act

May 13, 2011
Alberto Borges, MD

Too expensive; too unproven; and too burdensome. It's time to say goodbye to this unwanted legislation.

The use of EHRs has increased measurably in the past decade. After years of heavy lobbying, “enterprise” EHR vendors have convinced the White House and Congress that this technology has the capability to increase quality, decrease errors, and reduce costs (http://HCP.LV/j67k3v). The federal government has responded by introducing intrusive legislative bills that are costly to physicians, Medicare and Medicaid patients, and the American taxpayer (http://HCP.LV/mkV4px; http://HCP.LV/jORxfn).

Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331) empowers CMS to pay a bonus to physicians for successful e-prescribing, (http://HCP.LV/kLxeZj). It also mandates penalties for not e-prescribing beginning in 2012. One of the first bills signed by President Obama was the American Recovery and Reinvestment Act of 2009 (ARRA), which includes the HITECH Act, the cost to taxpayers for which has been estimated to be between $27 billion (http://HCP.LV/Lp2VTP) and $45 billion (http://HCP.LV/b9xQ8g) over the next 8+ years, most of which is unallocated and could be repealed (http://HCP.LV/jMyP8Q) if the Spending Reduction Act of 2011 (H.R. 408)becomes law.

I completely agree with the push to repeal the ARRA/HITECH Act; let me explain why:

  1. These laws, which will together eventually punish physicians who fail to meaningfully use an EHR and e-prescribe with a combined 7% in penalties, threaten to undermine the Medicare and Medicaid programs. They will force doctors who do not wish to own an expensive EHR system to abandon their participation in these programs. This will occur just when the number of elderly, sick, and poor patients in the United States is expected to soar (http://HCP.LV/kkHQAL).
  2. The only real winners are the EHR vendors themselves, along with consultants and lawyers (http://HCP.LV/kSAtQY), as doctors are being forced to purchase unwieldy technology estimated to cost as much as $40,000 (http://HCP.LV/LoDGTG) to $60,000 (http://HCP.LV/jTqxOe) per year. These costs are due not only to the actual cost of the EHR software and hardware, but also to the cost of data reporting and the added cost of negative workflow caused by the use of the technology while seeing patients. The Congressional Budget Office reported that total implementation costs for office-based EHRs ranged from $25,000 to $45,000 per physician, with annual operating, licensing, and maintenance costs ranging between $3,000 and $9,000 per physician. These figures are conservative and most likely will increase due to market pressures and vendor workflow shortages (http://HCP.LV/LwrtoZ).
  3. Small physician offices will continue to close as physicians join hospitals, which will decrease competition and increase costs to the consumer (http://HCP.LV/mCLMc5). There has been a flight of office-based internists to become hospitalists, from 6% of general internists in 1995 to 19% in 2006.These mandates may “possibly be the final nail in the coffin of the private U.S. medical practice” (http://HCP.LV/iULO5v).
  4. EHRs remain unproven (http://HCP.LV/jfC8vX; http://HCP.LV/Lk18LC; http://HCP.LV/L8bNjs) due to a lack of well-controlled, unbiased, prospective, well-randomized studies showing that EHRs actually improve significant outcomes. Numerous citations show that EHRs don’t influence outcomes (http://HCP.LV/iWVzA8) and may actually make matters worse (http://HCP.LV/b9xQ8g), introducing new types of errors, adding to the cost of doing business that will eventually be paid by the patient, and decreasing the quality of the physician-patient interview and examination.
  5. Few doctors will actually receive the meaningful use bonus.Billions are being spent on HITECH/meaningful use, yet according to a study published in Health Affairs, only 12% of physicians are eligible for incentives and already have a basic EHR (http://HCP.LV/m6Hsus). The CDC reported that as few as 2-4% of providers actually are capable of receiving the all-or-nothing payments, which is a very poor return on taxpayer dollars (http://HCP.LV/jA47G3).
  6. The failed installation/deinstallation rate for EHRs is estimated to be about 50% (http://HCP.LV/LhgSnB).
  7. Lack of privacy is a major problem that continues to plague centralized HIT programs throughout the world. Both patients and physicians are wary of private medical information sharing, as such information can be stolen (http://HCP.LV/mAueKB) or used to facilitate identity theft (http://HCP.LV/ixBg4q).
  8. The ability to universally interconnect doctors and hospitals (the central, most important mandate of the HITECH Act) continues to elude us, and will be a daunting task with more than 400 non-interoperable “certified” EHR systems in the marketplace (http://HCP.LV/kAwUHL).

Doctors and taxpayers are being asked to fund the expensive, unproven, and vendor-lobbied and —driven HITECT Act mandate that has failed to rapidly increase the adoption of EHR systems in health care. Congress needs to pull back the allocated, yet mostly unused, billions of dollars in funding. This money can better be used for either direct patient care or to pay down our country’s debt crisis.