How Do We Know the Health IT Program in the Stimulus Has Been a Success? Because It's Spent a Lot of Money


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How do federal health bureaucrats know that the $35 billion health information technology program has been a success? Because it's spent a lot of money already—almost $9 billion.

As a new report on the Health Information Technology and Economic and Clinical Health Act (HITECH), which was passed as part of the 2009 stimulus, notes, senior Medicare officials seem rather focused on the total volume of money spent as a measure of success.

The HITECH act provides incentive payments to health providers who adopt and install electronic health records systems. But the primary goal seems to be to get those payments out the door as quickly as possible.

The new report, issued by a group of Republican senators, notes that the program lacks a meaningful check on those who apply for the incentive payments. Providers simply self-report that they have met the necessary criteria—no documentary evidence necessary. The report suggests that "this would be like an individual claiming to have won the lottery but not being required to produce the winning lottery ticket in order to collect the payout."

Medicare's Office of the Inspector General (OIG) has warned that this is a potential problem. The OIG issued a report last year saying that Medicare "does not verify the accuracy" of the self-reported information by health providers claiming the incentives prior to payment—and even noted a few examples of providers who had reported themselves eligible, but had not actually met the requirements.

Yet officials at the Center for Medicare and Medicaid Services (CMS) did not agree with the OIG report's conclusion that additional checks prior to payment would be necessary. Why? Because it could delay the program's payments.

Never mind, in other words, whether the money is going to the right people, or being spent effectively. The important thing is that the money is being spent.

Indeed, officials in charge of that program have been explicit about that attitude. 

As the new GOP report notes, a senior Medicare official in charge of the health IT program has openly touted its success by pointing to the successful doling out of payments: "In the opening session of the 2012 Office of the National Coordinator for Health IT Annual Meeting, Farzad Moshashari, National Coordinator for Health IT, highlighted how much money has been spent and suggested it was the measure of success of the EHR program. He recognized the CMS staff who have helped facilitate the "$9 billion" that has been provided to states that 'had the highest proportion of eligible [providers] paid.'"

Meanwhile, even though providers are getting paid, the program is failing to achieve one of its key goals: interoperability. It's not enough to merely incentivize health providers to install electronic health records systems. For them to work the way the incentive program's boosters had hoped, they also need to be able to easily communicate with each other. That's not happening. As a study by RAND noted earlier this year, "the health IT systems that currently dominate the market are not designed to talk to each other." Instead, they're designed to lock providers into long-term relationships with vendors who maintain expensive proprietary technology systems.

In the end, these health records systems, which were sold as a way to reduce health costs in the long run by facilitating better record keeping and transfer, may end up costing taxpayers money. That's because they make it easier for providers to bill more to Medicare, by assisting them with Medicare's complex billing procedures.