Wednesday, March 25, 2009

Health IT provisions of American Recovery and Reinvestment Act of 2009

There is a great deal of excitement in the biomedical informatics field due to the health IT provisions of American Recovery and Reinvestment Act of 2009, also known as the economic stimulus package. There are two main health IT provisions in the economic stimulus package: incentives for “meaningful use” of electronic health records (EHRs) by physicians and hospitals ($17B) and direct grants administered by federal agencies ($2B). No grant programs have been announced yet, but an encouraging sign is the recent appointment of a new National Coordinator for HIT, Dr. David Blumenthal. The are also provisions in other areas of legislation that pertinent to health IT in other areas of the stimulus package, including comparative effectiveness research, NIH and other science funding, and broadband and other infrastructure funding.

The incentives for “meaningful use” of EHRs will be implemented through increased Medicare or Medicaid reimbursement starting in 2011. Non-hospital-based physicians will receive incentives based on Medicare or Medicaid charges, up to $64K. Hospitals will have an incentive base amount of $2M, which is adjusted by the hospital’s number of discharges, Medicare/Medicaid patient mix, up to $9M, and phased down over four years. After 2016, physicians and hospitals begin to have reimbursement penalties for not using EHRs.“Meaningful use” is likely to include CCHIT certification, e-prescribing capability, interoperability standards, and other features.

There are opportunities in this space for software vendors, consultants, health care organizations with existing EHR systems. There are also opportunities for educational programs to train users, implementers, and others.

The stimulus package contains a variety of other funding initiatives that will be led by the Office of National Coordinator for Health IT (ONC) now under the leadership of Dr. Blumenthal. A total of $2B will be distributed to a variety of programs. The legislation does not allocate specific dollar amounts of the specific programs. The ones most pertinent to our program include:
  • Sec. 13201 – Establishment of multidisciplinary Centers for Health Care Information Enterprise Integration, led by NIST, but involving other federal agencies, and funding research projects
  • Sec. 3012 – Health Information Technology Implementation Assistance, providing matching funds for Regional Health IT Extension Centers
  • Sec. 3013 – State Grants to Promote Health Information Technology, providing funding to states to facilitate and expand health information exchange
  • Sec. 3015 – Demonstration Program to Integrate IT into Clinical Education, providing grants to develop academic curricula integrating EHRs into clinical education of health professionals
  • Sec. 3016 – Information Technology Professionals on Health Care, providing funding for short-term (re-)training in informatics for IT and health care professionals in established educational programs
(A disclaimer about 3016: I wrote some of the words in it, and can honestly claim to have inserted the word "informatics" into the stimulus bill. Thanks to the staffs of Rep. David Wu and Sen. Ron Wyden for allowing me to help them draft the text. Naturally, OHSU's educational program is "shovel-ready" to train and re-train people for the jobs in health IT!)

The legislation provides other monies for health IT, some of which will fund biomedical research. There is $8.4 billion for National Institutes of Health for biomedical research. Some of this money is already being allocated, such as the newly announced NIH Challenge Grants program. Most of the money will be funneled to the 30 or so Institutes of the NIH, including the National Library of Medicine (NLM), which funds research and education in biomedical informatics. OHSU is already seeing some of this money in the expansion of our biomedical informatics training grant that will also provide funding for summer internships for both college students and non-research college faculty (e.g., community college and high school teachers).

The legislation also allocates $1.1B for comparative effectiveness research, which it defines as “research studies that compare one or more diagnostic or treatment options to evaluate effectiveness, safety or outcomes.” This money will be distributed by a variety of agencies, not only NIH but also the Agency for Healthcare Research & Quality and the Department of Health & Human Services. This is another area of key strength for OHSU.

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