President Obama's HITECH bill

April 6, 2009

I came across a very well written but totally misguided article written by Wayne J. Guglielmo called "Stimulus Package Has Billions for Healthcare." I have a couple of problems with its statements and would like to offer a rebuttal.

I came across a very well written but totally misguided article written by Wayne J. Guglielmo called "Stimulus Package Has Billions for Healthcare." I have a couple of problems with its statements and would like to offer a rebuttal:

>>> ARRA directs a significant $19.2 billion to this area, which the government estimates will lead over time to better quality of care, better care coordination, less duplication of services, fewer medical errors, and, ultimately, more cost savings.

Mr. Guglielmo, none of this has been proven. In fact, there are numerous WELL RUN STUDIES that show just the opposite, that certified electronic health records (c-EHRs) decrease quality, increase errors, have actually resulted in poor patient outcomes and even deaths, and will massively increase the cost of caring for our elderly population. I just finished writing a column at MD Net Guide yesterday where I calculated the 5 year cost of "significantly using" and reporting P4P data for 1 license of a c-EHR at just under $300,000.00 over 5 years (see http://www.hcplive.com/mdnglive/articles/PC_Medicare_HIT_mandate).

>>> Beginning in 2015, physicians who have not adopted HIT will be subject to decreasing Medicare payments, up to a 3% reduction by 2017 and beyond.

Actually, if you read the bill, it clearly states that the reduction can be up to 5% if at least 75% of physicians fail to comply. Any reduction in Medicare payments will not only be catastrophic, but the fact that hard-working poorly paid physicians will be penalized will result in a mass exodus of doctors away from the Medicare program just when the number of elderly will increase exponentially. If doctors can't make a profit due to a large overhead cost and due to excessive reporting requirements, they will leave and take on more HMO and PPO patients which are easier to see and currently pay 20% to 40% more than Medicare (i.e. before the cuts).

>>> Is this carrot-and-stick approach the way to go? Yes, says Patricia B. Wise, vice president of the Healthcare Information and Management Systems Society (HIMSS)...

Why in the world would you ask that question to the VP of HIMSS, the vendor group whose members stand to make a massive windfall if doctors sheepishly comply with these mandates? Would you really expect her to say anything but a resounding "YES!"??? What were you thinking? (eyes rolling)

>>> He also thinks the stimulus had another good effect—it lightened the load of future healthcare reform: "There are some things—like HIT—that such reform doesn't have to grapple with as much because they got a big jumpstart in the stimulus package."

Boy, you guys really think that this bill is a slam-dunk! Right now, nationally, only 4% of physicians are "significantly using" c-EHRs the way that the HITECH bill wants. Even in Massachusetts, where they have been pushing socialized health care and c-EHR for years, they've achieved at most 5% "significant use" of c-EHRs (see http://assets1.csc.com/health_services/downloads/CSC_Adoption_of_EHR_Capabilities_in_Massachusetts_Physician_Practices.pdf). I don't think that President Obama and his staff have thoroughly thought out the scenario where noncompliant physicians may simply walk away, avoiding the penalties of noncompliance or high cost of compliance, both bad choices, and killing this push for c-EHR, and possibly the whole Medicare program, once and for all. The elderly will be left without enough providers to care for them, resulting in increased morbidity and mortality.

I know this because back in 2002 I had to write a 4 page letter to the Virginia BCBS "Capital Care" plan similar to this and subsequently I personally dropped 600 patients, as did numerous other physicians due to inadequate payment schedules. Even though the company actually responded with a 20% pay increase (I called for a 50% increase), they eventually folded 6 months later. This $19.2 billion could have been better spent on supporting health clinics for the poor. It could have helped support vaccination programs for children without any other means of health care. It could have helped support the care of uninsured diabetics, uninsured people with cancer, and uninsured people with other catastrophic illnesses that is is overwhelming community charity programs and emergency rooms. It could have gone to shoring up hospitals, many of which are near bankrupcy.

This $19.2 billion that will be used to push for an unproven c-EHR initiative is a product of power, bribery, kickbacks, and greed. Many of President Obama's HIT staff are lobbyists that have poured tens of thousands of dollars into his campaign for the presidency of the United States in the hope of influencing HIT legislation. From my perspective, this is Mr. Obama's a quid pro quo, a kickback, a way of rewarding them for their contributions. He's surrounded by representatives from many of the very "enterprise" companies that comprise HIMSS- s.a. GE (Blumenthal), Allscripts (Tullman), and Cerner (DeParle). This month one of Mr. Obama's appointees, Vivek Kundra, who had served Mr. Obama for only one week before being placed on administrative leave, had his former office raided by the FBI with some of his former associates charged with bribery of a public official, money laundering, wire fraud and conflict of interest. (download my PPT presentation for the specifics here)

In conclusion, this article is ill-informed attempt to bolster the chances of the HITECH bill or simply a document written by a representative of the HIMSS/"enterprise" c-EHR industry. This $19.2 billion HITECH bill is an expenditure that is a complete waste of taxpayer money that should be repealed immediately.