Medical Device Daily Washington Editor
WASHINGTON – The healthcare information technology (HIT) bill (HR 4157) sponsored by Rep. Nancy Johnson (R-Connecticut) – intended to encourage “the dissemination, security, confidentiality and usefulness of health information technology” – recently managed to squeak out of the House Ways and Means Health subcommittee. And despite the expected share of controversy over privacy, the subcommittee managed to cobble together a party-line vote on H.R. 4157 last Wednesday to send the bill to the full committee.
However, a vote on language intended to ensure privacy, offered by Rahm Emanual (D-Illinois), failed in a party-line vote by the subcommittee Monday night, Republicans voting against, Democrats for.
That vote appeared to be focused more on procedural issues rather on the issue of privacy, which all agree is important.
At least one observer said that these party squabbles will not be hashed out until the House confers with the Senate to deal with disparities between Johnson's bill and S. 1418, the so-called Wired for Health Care Quality Act, which the Senate passed last year.
Emanuel's amendments would have made explicit an individual's right to privacy with respect to identifiers in patient information, as well as requiring patient consent before release of records between providers and/or payers.
Johnson is said to be interested in dealing with this and other issues after moving H.R. 4157 through the House.
The privacy issue has probably generated the most copy and the most rhetoric.
Deborah Peel, MD, chairman of the Patient Privacy Rights Foundation (Austin, Texas), describing itself as a national consumer watchdog organization, yesterday issued a statement blasting the party line vote that turned down Emanuel's privacy amendments.
Peel said that vote serves to deny the medical privacy rights of Americans.
“Without these amendments, patients have no control over who sees and uses their medical records and are left vulnerable to companies that want to profit from patients' health histories or discriminate based on people's current and previous medical conditions.”
Peel did not take a stand against the conversion of paper to electronic files as intended by the Senate and House bills being offered. Rather, her concerns were based on recent difficulties at the Veteran's Administration as a cause for concern.
“If the Veterans Administration can't prevent the data theft of 26.5 million names, Social Security numbers, and diagnosis codes for their veterans, why should patients believe their personal, sensitive health data is any safer in electronic files?” Peel asked.
Another point of controversy for H.R. 4157 is that it calls on providers to adopt the International Classification of Diseases 10 (ICD-10) standard for medical coding (the ICD-X series was originally designed to track sources of mortality, whereas the clinical modification sets, known as ICD-X-CMs, are built around the original mortality system to report on morbidity as much as mortality).
In March, Mary Nell Lehnhard, senior vice president of the Blue Cross/Blue Shield Association ,said that the expectation embodied in Johnson's bill that insurers and providers could migrate their systems to ICD-10 by the beginning of October 2009 was “unrealistic and unwise,” due to “the enormous scope of the change and the required participation by providers, employers, payers, and the federal government.”
On the other hand, in a press statement earlier this month, Stephen Ubl, president of the Advanced Medical Technology Association (AdvaMed; Washington), said that the document presented by the Blue Cross/Blue Shield Association in support of its position “lacks specificity and contains no solid data to support its conclusions” (Medical Device Daily, May 23, 2006).
Ubl argued that as long as U.S. healthcare systems continue to run with ICD-9, and not adopt ICD-10, “it will be difficult to track new and emerging public health threats, such as avian flu.”
Another feature of the bill would create exemptions to Stark self-referral and other anti-kickback laws that could impede hospitals and other provider establishments from sharing technology with physician practices.
However, as the bill currently stands, it would forbid the use of referrals in exchange for assistance with the cost of implementing HIT in physician practices.
Still, House Democrats were none too pleased with the Stark exemptions for fear that fraudulent practices would ensue.
Rep. Pete Stark (D-California), who authored the law bearing his name, decried the House bill, commenting that while S. 1418 “is less than perfect,” it would be preferable to “this turkey we have before us today.”
Johnson's bill would also require that HHS decide one way or the other within 90 days whether to adopt any coding standards recommended by the National Committee on Vital and Health Statistics (NCVHS). This committee, formed in 1949, is charged “by Congress with advising the federal government on the information needs underlying health policy,” according to its web site.
Don Asmonga, director of government relations at the American Health Information Management Association (AHIMA; Chicago) told Medical Device Daily that despite the controversy, he expects Johnson's bill to fare well.
“The prospects for getting it through the Ways and Means Committee are fairly high,” Asmonga noted, adding: “I think they'll get it on the House floor by the end of June.”
Asmonga said that he expects the Ways and Means Committee and the full House to give Johnson's bill the usual partisan scrubdown.
“I would like to think that there would be some Democratic defections,” he said. Nonetheless, he said he expected that Democrats will “march in unison.”
Few, if any, Republican defections are expected at AHIMA.
“I think that if anyone is great at herding cats, it's Bill Thomas [R-California] and Nancy Johnson,” he said.
Thomas chairs the House Ways and Means Committee.
Asmonga also remarked that if the House passes H.R. 4157, the Senate will likely waste little time in convening with the House to craft a compromise.
“The Senate has been there and done that,” he said, adding that he believes the Senate is eager to send something to the White House.