Healthcare promises to be a huge campaign issue in the 2008 election, political advisors for both major parties say. But well before then, President Bush wants to leave a positive legacy, calling for what he has coined “value-driven healthcare.”
This plan will require electronic health records for every American and aims to lower the cost of healthcare while improving quality. The sidekick to this plan is called pay for performance, or P4P.
A first step toward P4P came on December 9, when Congress passed a measure that will include a 1.5 percent Medicare payment increase – beginning in the second half of 2007 – for physicians who voluntarily submit data to the Centers for Medicare & Medicaid Services on applicable quality measures.
Experts who work with physicians are skeptical. Chris Weiss, president and CEO of Dynamic Clinical Systems, a patient-centered, online electronic medical record company in Hanover, N.H., summed it up by saying no amount of incentive will entice physicians to participate if they are hesitant about pay for performance; doctors are afraid of private payers and they want control over the care they give.
Unfortunately, good will won’t accomplish what funding can. Progress toward healthcare advancement in Washington will come down to money, and money is tight. With the newly reinstated pay-as-you-go rule in Congress, everything moving forward will have to be paid for with something already in existence. This principle will heat debates and more than likely will slow progress.
Both parties agree they want to see healthcare information technology advance, but how to get affordable technology into the hands of physicians is the rub. With no federal cash cow to fund this advancement, many ideas have developed. One calls for hospitals to loan or give the technology to physicians; antitrust concerns have fueled debates, which have not been resolved to the point where a bill can be passed.
Rep. Phil Gingrey (R-Ga.) plans to try again with a tax break bill for physicians who want to purchase HIT, and he believes it can gain enough bipartisan support to pass this time.
The new Democratic coalition in Congress and the Health Information and Management Systems Society are aligned to develop HIT legislation that they believe will pass this year through strategic efforts that include breaking up the bill into passable pieces.
So creativity will be the rule as Washington tries to advance essential pieces of healthcare payment reform – while trying to do so within the constraints of a zero-sum budget.