Will HIT incentives be subsumed by spending cuts?
Health IT's hallowed bipartisan support ostensibly survived the presidential election and, subsequently, the fiscal cliff debate – but as the budgetary battles trudge on in Washington that fate is not so guaranteed as it once seemed.
"We have to be careful to distinguish between opinions about health IT or opinions about stimulus spending in the era of a significant economic recession," said Scott Lundstrom, group vice president of consultancy IDC's Health Insights unit.
There are two issues at play here: unfiltered support for health IT apart from backing the stimulus against support for reducing spending.
"Stimulus – only about half of that money has been paid out. So there's a $10 billion pile of cash there still waiting to be disbursed and that looks like an attractive target for people trying to cut spending," Lundstrom explained. "On the health IT side, we have to look at why we implement IT.
Typically, we implement IT to become more efficient, to execute processes more effectively, to improve quality, to control costs, and I think there's fairly broad support for that."
The political differences come down to whether the federal government should seed health IT tractions with financial incentives, or leave it to market forces driving hospitals and health networks to stay competitive as profit-seeking entities.
Healthcare Finance News' sister publication, Government Health IT found in a poll that 40 percent of its readers expect health IT's bipartisan support to continue because digitizing the healthcare system is important to both parties, while 36 percent suggested that private market momentum would advance HIT regardless of government involvement. The remaining 25 percent voted that opposition to health IT is brewing hotter, percolating since the September letter four congressmen sent to Kathleen Sebelius, secretary of the Department of Health and Human Services, suggesting suspension of the meaningful use reimbursements.
"I don't think there are many people who will argue that (health IT) infrastructure across this country will save money in the long run," said Carol Robinson, state coordinator of health information technology for Oregon. "But it's that investment period where we have to put up the power grid or the oil pipeline in order to get to that future state, and that's where we are and how it needs to be discussed."
That financial investment is so steep, Lundstrom added, because the technology stack required is prohibitively sophisticated, complicated, downright obstinate to implement for the uninitiated – those being the community hospitals, physician practices and small clinics comprising so much of the provider community who won't be able to crawl up that hill.
"Hopefully," Robinson said, "conservative lawmakers will see the value in making those kinds of investments, as well as those of us who are more socially-driven."
It's not just conservatives seeking to curb spending. Democrats are also, to a certain extent.
"Reducing federal spending is an essential element of a balanced approach to our fiscal challenge, and healthcare costs constitute a large proportion of non-defense expenditures, so it's a natural place to look," said Jim Douglas, a former four-term Vermont governor who is now a member of the Bipartisan Policy Center's Governor's Council and executive-in-residence at Middlebury College.
"Some may regard it as easier to cut something that hasn't yet matured, so HIT may be deemed more vulnerable," said Douglas. "Others, for partisan reasons, may see this as an element of the president's healthcare legacy and try to curtail outlays on that basis. I assume that it's not philosophical or a matter of concern on the merits, but rather an understandable exploration of possibilities for lower spending."
