Health IT bill to ease anti-kickback regs, put NCHIT in charge of standards - now delayed

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Last week The House Energy and Commerce and Ways and Means committees voted in favor of two versions of the same health IT related bill (HR 4157). The bill sets out to empower the HHS’s Office of the National Coordinator for Health IT to oversee standards for storing medical related data and standards development relating to interoperability in a timely fashion. However, this week the bill was put on hold over concerns that it could increase overall federal spending and decrease revenues.

The Ways and Means approved bill includes a section established to create a “Safe Harbor” within Stark and anti-kickback laws so that healthcare facilities can more easily provide physicians with technology and support services dedicated to the sharing of electronic health information. The provision states that entities that donate technologies may not set conditions or limits on the technology being donated.

Also, unlike the Energy and Commerce committee’s version, the Ways and Means bill provides for an increase in the amount of procedures and billing codes current available – now 24,000 – to as many as 200,000 by 2009. However, this provision is still under debate.

The Energy and Commerce committee version sets deadlines for the National Coordinator, requiring a published strategic plan for these initiatives by year’s end. By August 2008, the Coordinator will have to have conducted surveys as to the electronic health information exchange compatibility between entities on the federal, state and local levels. A year later, the National Coordinator will have to endorse interoperability guidelines. The National Coordinator position is currently vacant following the resignation of David Brailer, MD, PhD in April. Until a replacement for Brailer's position is announced, the work of the Office of the National Coordinator continues under the leadership of the four permanent directors of the office.

Funding through grants and other means has been a controversial element of these bills ever since the Senate last fall approved its own version of the legislation which included funding sources to be available for providers. The House versions pushed through committee do not include such funding opportunities.

The delay in a floor vote on the bill stems specifically from concerns that arose after the Congressional Budget Office did a review of the bill and found that the called-for changes to the Social Security Act could be potentially problematic. The changes would create “safe harbors” for donations of health IT would that would, as the CBO states in a letter to the Ways and Means committee, eliminate “monetary penalties, criminal penalties, or sanctions for violating the prohibitions on certain physician referrals.”

Also, the CBO cautioned that the bill in its current form would cause health plans, providers and other players to use the 10th revision of the International Classification of Diseases three years earlier than originally planned in 2012. This considerably more abrupt shift to the updated version of the classifications would create “substantial” costs to providers and claims processors, according to the CBO.