Health IT and Quality Provisions included in House SCHIP Reauthorization Bill
With the September 30th expiration date of the State Children's Health Insurance Program (SCHIP) and members of the House and Senate approaching August recess, reauthorization bills were passed separately in both chambers last week. The House version contained provisions related to health IT (HIT) and quality measures under the Medicare program.
The House SCHIP bill (H.R. 2162), which passed on August 1, would expand the SCHIP program overall by nearly $50 billion dollars over the next five years. The bill would also reduce payments to Medicare Advantage plans while increasing the federal cigarette tax by 45 cents per pack. The bill also contains provisions regarding the use of HIT within Medicare.
Under title three of the bill: Physicians' Service Payment Reform, the bill calls for an improved and expanded medical home demonstration project. The Secretary is authorized to select up to 500 medical homes to participate in this expanded project and will give priority to 100 "HIT-enhanced medical homes." The project would be authorized to operate for three years beginning in October of 2009.
These "HIT-enhanced medical homes" would use best practices for patient care and management, including outcome measurement and patient education capabilities, as well as specific standards relating to the use of EHRs and e-Prescribing.
Section 905 of the bill calls for the Secretary of HHS to undertake a study regarding implementing a "health information technology system for all health care providers under the Medicare program." This study would examine the feasibility of implementing an interoperable health IT system for Medicare providers that utilizes clinical decision support, patient tracking and reminders and e-prescribing, with appropriate privacy and security protections. The study also asks the Secretary to examine the use of technology that is open source or has been developed by the government, which many believe specifically refers to the use of the VistA system utilized within the Veterans Administration. Congressman Pete Stark (D-CA), who chairs the House Ways and Means Health Subcommittee, has long been an advocate for VistA.
Furthermore, the bills calls on the Secretary to designate an organization, such as the National Quality Forum, to create a national strategy and process for setting priorities and goals in establishing healthcare measures as well as advancing the use of EHRs nationwide.
H.R. 2162 addresses the projected 10 percent cut in physician reimbursements anticipated for 2008 under the Sustainable Growth Rate Formula (SGR), as well as the five percent cut in 2009. The bill replaces these cuts with a .5% increase for each of those years.
The House bill also repeals the voluntary "Physician Assistance and Quality Initiative Fund" which is more commonly referred to as the Physician Quality Reporting Initiative or PQRI. The PQRI program was created under the Tax Relief and Health Care Act of 2006, which also called for the creation of structural measures to measure HIT use in 2008.
The Senate SCHIP bill was passed August 2nd by a veto-proof 68-31 margin. The Senate bill would increase tobacco taxes on cigarettes to $1 per pack, but does not contain the quality or HIT-related provisions that are included in the House bill.
The two chambers will now undergo the process of reconciling the two bills following the August recess. The President has vowed to veto a final bill if it he feels it would draw those receiving private health benefits into the publicly funded SCHIP program.
