Privacy, Health IT Funding Total in Flux as Senate Takes Up Stimulus

The House and Senate versions do take subtly different approaches to time lines for the adoption incentives. The House offers phased out payments beginning at $15,000 for providers who are “meaningful EHR user(s);” the Senate Finance bill offers the same phased out approach and payment amounts, starting at $15,000, but will give $18,000 to professionals who are ready to go in 2011 or 2012. The Senate also refuses incentive payments to professionals who adopt health IT after 2014. The bills also build incentives into the fee schedule for services, but the Senate version begins building in fee penalties in 2015, while the House waits until 2016. Other spending differences the information management society found include an extra $3 billion, to a total of $5 billion, for the Office of the National Coordinator, an office that the bill codifies, and an additional $300 million, to a total of $850 million, for Indian Health Services to spend on health IT activities and equipment.

While the Congressional bodies work out the money differences, they'll also have to find a balance on privacy concerns. House Ways and Means and Commerce Republicans raised concerns about how the provisions against selling personal health information to third parties for marketing purposes could affect pharmacists’ communications with patients. The House Commerce Committee adopted an amendment by Rep. Roy Blunt, R-Mo., that spelled out that the bill doesn’t prevent pharmacists from communicating with patients, or even from getting paid to provide patient information to third parties to conduct those communications, provided the payments don’t exceed out-of-pocket costs. Democrats, however, changed the wording of the amendment after it was adopted, Blunt’s spokesman said, removing Blunt’s language requiring the Secretary of Health and Human Services to develop guidelines within 180 days allowing for remuneration and replacing it with language saying the secretary “may” develop such guidelines. Blunt doesn’t support the change in language. The Senate doesn’t have a similar provision. Instead, it provides that communication is allowed if a health care item has previously been prescribed or administered to the recipient.

Deven McGraw, director of the Health Privacy Project at the Center for Democracy and Technology, said the two provisions appear aimed at slightly different issues. The Senate provision appears aimed at communications that usually come with a prescription describing the drug and side effects; those communications are paid for by the pharmaceutical companies, and there were some concerns the legislation could require patient authorization to receive them. The House provision provided for a broader array of communications, she said, but was stricter about the money. “In some respects, I think the House provision was a much more careful consideration,” she said.

The National Association of Chain Drug Stores has complained about what it considers over-broad privacy provisions. Though it approved of the Blunt amendment, the group still found “significant problems” with the bill. Executives spoke out against the provisions at an association conference Monday, saying the provisions could hinder health IT adoption and harm patient care.

Health care providers also appeared dubious of the privacy provisions. Allscripts released a survey of doctors, medical group executives and staff that found 61 percent of respondents who already used EHRs “want to move forward without waiting for new privacy standards.”