"Stimulus Watch: Investment In Health IT Can Boost Primary Care"
Yesterday, the House Energy and Commerce Committee marked-up the health care portion of the economic stimulus. Here are the guts of the proposal:
- Subsidizing COBRA: The bill provides a 65% subsidy for Cobra premiums to workers involuntarily terminated between Sept. 1, 2008, and Dec. 31, 2009. The assistance, expected to cost upward of $30 billion, would cover premiums for up to 12 months and would end sooner for those who get hired and are offered employer-sponsored health-care coverage.
- COBRA as stop-gap: The bill would permit Cobra-eligible individuals who are 55 years or older and who have worked for an employer for at least a decade to retain Cobra coverage at their own expense until they become eligible for Medicare at age 65, or secure a new job with health-care coverage.
- Increasing Medicaid funding: Medicaid would receive upward of $87 billion under the bill, with additional federal matching funds to help states maintain their Medicare programs through 2010.
- Investing in Health IT: Information technology would get $20 billion of federal funding under the bill, which calls for the Department of Health and Human Services to develop standards by 2010 for a nationwide system to exchange health data electronically.
Health care wonks interpret the stimulus as a down-payment on broader health care reform. Cover more Americans now and the road towards universal coverage will be a little bit easier and less expensive, they argue. The more Americans have health insurance and access to regular care, the less health care costs they incur once they’re brought into the system.
As Dean Waldman suggests over at the Huffington Post, “Health is infrastructure. Health care is the maintenance and repair service for this key element of our productive capacity. As a nation we need to treat the health of our people just like repaving a road – as an investment in our future.”
And Obama does this two fold: he gets more people into the system and lays down the infrastructure for the expansion. The lessons of the Massachusetts Health Care Reform Plan of 2006 “make it clear that an expansion of insurance coverage quickly uncovers the debilitating problem of the crumbling infrastructure of primary care. In Massachusetts, inadequate primary care capacity resulted in many newly insured residents not being able to find a medical home and gain access to medical care.”
Nationally, “the trajectory of the supply of primary care physicians for adult patients is now falling behind the growth of the adult population” and HHS estimates that “by 2020 there will be a shortage of 66,000 primary care doctors nationwide.”
The slowing growth in primary care physicians is traditionally attributed to the pay gap between generalists and specialists but Kevin Grumbach at Health Affairs blog argues that even “more consequential is the lack of investment in the core infrastructure of primary care“:
Specialists, who spend many of their work hours in operating rooms, hospital wards, come-and-go surgery and endoscopy centers, and imaging facilities, have much of their practice infrastructure… Primary care physicians spend most of their work hours in ambulatory care in their own offices and clinics, paying all practice overhead from their own billings. Purchasing and maintaining an office-based electronic medical record and hiring an extra staff person to work with diabetic patients on self-management skills are daunting expenses for a small primary care office operating on the slender margin of “evaluation and management” billing codes. Equally problematic is obtaining the technical assistance to effectively deploy these types of modernization and practice improvement resources.
Investing in Health IT not only saves money, creates jobs and reduces medical errors, but it also helps primary care physicians — who often bear the burnt of tech implementation without seeing immediate benefits — afford the infrastructure for expansion. Done correctly, Health IT can truly serve as the “infrastructure” of broader reforms.
Of the $20 billion, $18 billion is deferred until 2011, when it will start being offered as incentives to physicians who are already using EHRs. In other words, physicians have to invest their own money –and do so within the next few months– in order to be ready to start claiming the funds. It doesn’t strike me as realistic and it’s certainly not a near-term stimulus. It’s actually more like an unfunded mandate since it’s likely the availability of the $18B in 2011 on out will let Medicare and Medicaid pay lower rates than they otherwise would.