The prognosis for passing a healthcare IT bill in the 109th session of Congress appeared very bleak in early October.
Lobbying groups were all but giving up hope that Congress would find the time or feel the urgency to pass the bill after the elections. The lame duck session, which begins November 13, is likely to be consumed by nine appropriation bills needed to keep the government operating.
It appears likely that the two bills - HR 4157, the Health Information Technology Promotion Act, and S 1418, the Wired for Healthcare Quality Act - will not be reconciled by a conference committee and thus will not reach either side for a vote, despite widespread support for healthcare IT.
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Besides a number of IT-related provisions, the bills contain a more favorable approach for enabling hospitals to contribute technology to physician practices in their delivery area without running afoul of laws, named for Rep. Pete Stark, prohibiting payments that could be construed as bribes for admissions.
On October 10, exceptions and safe harbors from the Department of Health and Human Services and the HHS Office of the Inspector General went into effect, establishing situations under which hospitals and healthcare networks could contribute software applications to physician practices.
Industry groups are hoping to get the IT bill passed this year, in part because it has more generous provisions, including the donation of hardware to physician practices, which is not permitted under the HHS/OIG regulations.
However, while disappointed that an IT bill probably will not pass this year, healthcare IT proponents are optimistic that information technology in healthcare will make its mark in the 110th session of Congress.
In fact, 62 healthcare IT bills were introduced in 2006, said Dave Roberts, vice president for government relations for the Healthcare Information and Management Systems Society.
For example, one potential bill for next year, HR 4641, is sponsored by Rep. John Gingrey (R-Ga.). Gingrey's bill would provide tax incentives to medical care providers purchasing IT equipment or services.
The House bill contained a deadline for implementing a new version of the International Classification of Diseases that was divisive in the healthcare industry. Pat Smith, senior vice president of government affairs at the Medical Group Management Association, said his group could not support the bill if it included a 2010 deadline for implementing ICD-10.
The HHS-OIG exceptions to the Stark laws probably will not cause healthcare organizations to rush to donate goods.
Rod Piechowski, vice president for technology leadership at the National Alliance for Health Information Technology, said physician practices would still have to pay 15 percent of the cost of any software they receive under the exceptions, and it's not certain if hospital organizations would be allowed or able to support offsite physician offices.
"I don't think it's going to be like Independence Day tomorrow," said Allen S. Weiss, president and CEO at NCH Healthcare System of Naples, Fla., on October 9, the day before the new rules went into effect. "A quarter of the health systems in the country are in the red, and half of the rest are existing on thin and shrinking margins. It's a question of who's paying for the infrastructure, which is not inexpensive."
Most physician practices are in no position to fund ongoing support of IT, said Tip Ghosh, CEO of the Bloomsbury Consulting Group of Las Vegas. "Even if you removed restrictions on Stark exceptions completely, it's hard for small physician practices to move forward on EMRs."
Also, some question whether not-for-profit hospitals would be able to donate software to for-profit physician practices without running afoul of Internal Revenue Service rules. There has to be a demonstration that such donations are for the public good, Piechowski said.
Editor Fred Bazzoli contributed to this story.