GOP Senators Express Concerns Over Implementation of HITECH Programs

Six Republican senators have sent a letter to HHS Secretary Kathleen Sebelius expressing concerns over the Obama administration’s implementation of the Health Information Technology for Economic and Clinical Health Act (HITECH).The senators are concerned about “the lack of data to support the Administration’s assertions that this taxpayer investment is being appropriately spent and actually achieving the goal of interoperable health IT.” HITECH was enacted in 2009 as part of the American Recovery and Reinvestment Act (P.L. 111-5); one of its key purposes was to promote the meaningful use of health IT by healthcare providers and practitioners.

In addition, the senators released a 28-page white paper asking the Obama administration to “reboot” HITECH and to provide answers on issues including interoperability, increased costs, potential waste and abuse, patient privacy, and sustainability. The senators requested a response from Sebelius by June 16, 2013.

The senators note in their letter and report that HITECH provides for expenditures of $35 billion over 10 years to implement the various programs included in the legislation. In addition to asking Sebelius to provide a list of every contract or task order awarded to perform work related to the HITECH Act, the senators specifically ask for more details regarding contracts between the Office of the National Coordinator of Health IT (ONC) and CMS and private organizations such as Mathematica Policy Research, the National Opinion Research Center at the University of Chicago, Beacon Communities, and the American Institute for Research.

Implementation Deficiencies

The white paper highlights five “implementation deficiencies” –

  • interoperability: the senators state that “early reports suggest that federal incentive payments are being made without clear evidence that providers can achieve “meaningful use,” or the ability to use the health IT program internally, and without an adequate plan to ensure providers can share information with each other.
  • increased costs: while HTECH was estimated to save the Medicare and Medicaid programs a total of about $12.5 billion through 2019, the senators noted that “health IT may have actually accelerated the ordering of unnecessary care as well as increased billing for the same procedures.”
  • lack of oversight: the senators note anecdotally that they had heard of “‘money spent’” being used as a metric of success, rather than specific, concrete program goals and tangible deliverables that are focused on achieving interoperability.” The senators questioned whether the administration has the mechanisms in place to prevent fraud and abuse in implementation of HITECH.
  • patient privacy: the senators note that an HHS Office of Inspector General report noted that security procedures in place at ONC and CMS “are lax and may jeopardize sensitive patient data.”
  • program sustainability: the senators also noted that providers who receive incentive payments to improve their health IT may not be able to maintain those systems after the initial federal money dries up.

Ongoing Concern

This is not the first time Senate Republicans have expressed concern about HITECH. Last October, four Republican senators requested a meeting with Sebelius and staff from ONC and CMS to address several concerns related to the final rule on adoption of electronic health records (EHRs) and the implementation of the Stage 2 of ONC’s “meaningful use” program. Other senators requested that Sebelius suspend the distribution of EHR incentive payments until HHS promulgates universal interoperable standards.