ARRA Update: Opportunities and Risks for Health IT

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The American Recovery and Reinvestment Act of 2009 (ARRA), signed into law on February 17, includes $19 billion in funding for health care IT initiatives through the Health Information Technology for Economic and Clinical Health Act (HITECH). How these funds will be distributed, however, remains unclear, and radiology practices and hospital radiology departments hoping to receive HITECH funding should begin planning a strategy immediately.

“The ARRA is, if nothing else, an extraordinarily ambitious law. Health IT has gone from an essential component, a supporting backbone to our health care system, indirectly funded, not regulated, to a directly and heavily regulated, heavily subsidized industry of its own, and it happened in minutes.”
--Howard Burde, JD

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Chuck Christian, CIO

“The questions that are going to be answered for us in the next weeks and months are: Who has the money, where is it, how do I get on the list, and how do I line up my organization to get access to it?” according to Charles Christian, CIO and health systems manager of Good Samaritan Hospital, Vincennes, Ind, and chair of the board of directors of the Healthcare Information and Management Systems Society (HIMSS). Christian, who copresented A Strategic Approach to Managing Opportunities and Risks for Health IT in Economic Stimulus at the HIMSS meeting in Chicago on April 6, urged members of the imaging community to take an active role in shaping the terms contained in the legislation, noting, “The act not only authorizes the funds, but it also appropriates the funds: The money is there.”

At issue is the legislation’s reliance on the term meaningful use. Seventeen billion of the $19 billion in funding is reserved to pay incentives, through Medicare and Medicaid, for physicians and hospitals implementing health IT by 2014. The other $2 billion will be distributed through the Office of the National Coordinator for Health IT for projects including a health-information exchange infrastructure, standards development, and state grants to further the adoption of electronic medical records (EMRs). In order to qualify for these incentives, however, a provider must demonstrate meaningful use of certified EMR technology, raising two questions: How is meaningful use defined, and what will the certifying body be?

Howard Burde, JD, Christian’s copresenter at the HIMSS conference, is a HIMSS board member, and a partner and leader of the health law practice group at Blank Rome LLP, Philadelphia. He says, “The ARRA is, if nothing else, an extraordinarily ambitious law. Health IT has gone from an essential component, a supporting backbone to our health care system, indirectly funded, not regulated, to a directly and heavily regulated, heavily subsidized industry of its own, and it happened in minutes.”

Burde warns providers that the incentives provided by HITECH should not be viewed as handouts. “They could make meaningful use so burdensome and so difficult that providers will have a tough time complying and, therefore, a tough time drawing down Medicare and Medicaid funds,” he says.

So far, there are still more questions than answers regarding the language used in the legislation. The Certification Commission for Healthcare Information Technology (CCHIT) seems like a natural choice for the certifying body, but a decision is yet to be made. According to John Morrissey, press officer for CCHIT, “All we know, at this point, is that the language of the law says that the Office of the National Coordinator may keep or recognize a voluntary certifying body or bodies, and we are the only one to keep at this point, and we are the only one officially recognized, but we are waiting for the official word.” Morrissey anticipates knowing more in the coming month. He says, “They have to have a plan of action by the end of this year, and the number of regulatory and approval processes that this constitutes is not trivial, so in order to get through that process, they’re going to have to make some decisions in a fairly expeditious way.” (See sidebar for more information on the ARRA timeline.)

Meanwhile, HIMSS has stepped up to the plate on the term meaningful use, volunteering its own definition for adoption by CMS. For hospitals to be eligible for incentive payments, HIMSS suggests that they must use health IT in a meaningful manner, which would include exchanging electronic health information to improve the quality of care, as well as submitting clinical quality measures