All throughout the Supreme Court hearings over the constitutionality of the healthcare reform law and even during the deliberation of the justices, commentators said regardless of the decision handed down, the government’s health IT initiatives would remain untouched. In the most technical sense possible this was true. The meaningful use program gets its funding through another law. Striking down the Affordable Care Act would not have affected this program. But at a more essential level this seems dishonest.
There are all kinds of provisions included in the reform law that lean heavily on IT. None of these may be so direct as the meaningful use incentive program in encouraging the adoption of EHRs or other technology, but there are pretty meaningful incentives included in the law that encourage the transition to a networked system. Health IT stakeholders should be thankful that the court ruled the way it did. Otherwise it could have set the adoption of technology in healthcare back significantly.
The most obvious example is the Medicare Shared Savings program, which rewards doctors for operating as accountable care organization and for keeping patients well in order to reduce costs. This program doesn’t necessarily require the use of EHRs, but it sure makes it hard to qualify for practices that don’t. Several of the quality measures physicians must comply with in order to qualify give extra consideration to professionals who use the technology.
And in fact, the two programs are much more intertwined than some may realize. In announcing the Stage 2 meaningful use rules, national coordinator for health IT Farzad Mostashari said that the meaningful use reporting standards will be aligned with those of the Shared Savings program, as well as other Medicare/Medicaid incentive programs.
Even if aspects of the Affordable Care Act and meaningful use were not directly linked, it would be hard to ignore the philosophical connections. Both have at their heart a desire to network physicians, encourage patient-centered care, and leverage innovation, all with the goal of making care more efficient and affordable.
The reform law seeks to accomplish these goals by organizing physicians into accountable care organizations. The meaningful use program gives physicians the tools necessary for operating in a more collaborative environment. The programs may not come from the same piece of legislation, but in a sense they are two separate legs of the same stool.
Striking down the reform law may not have eliminated the direct financial incentives for adopting EHRs, but it would have removed a more overarching motivation for using EHRs in the first place. Technology use in and of itself is not necessarily a worthwhile goal. But using technology to facilitate the free exchange of health information and delivery of truly collaborative care is. This is what the combination of the Affordable Care and HITECH Acts provide.
In the wake of the court’s ruling, the health IT industry has largely acted as if none of this were at stake. The meaningful use incentives were protected either way, and therefore the industry would have remained unaffected, for the most part.
This reaction seems a bit like people are forgetting what the meaningful use program is about in the first place. If the country is going to get healthcare costs under control and start improving outcomes, broader EHR use is a good start. But these goals will only be achievable when technology use is combined with meaningful changes to the way care is delivered and paid for. In this sense, striking down the Affordable Care Act would have delivered a major blow to health IT initiatives.