June 17, 2005
The Honorable Bill Frist
509 Hart Office Building
U.S. Senate
Washington, DC 20510
The Honorable Hillary Clinton
476 Russell Office Building
U.S. Senate
Washington, DC 20510
Dear Senators:
On behalf of the 94,000 members of the American Academy of Family Physicians, I am pleased to inform you of our support for the farsighted provisions of the Health Technology to Enhance Quality Act that:
Health Technology to Enhance Quality Act (S. 1262, Frist-Clinton)
- establish the Office of the National Coordinator of Health Information Technology (ONCHIT),
- are designed to promote a national interoperable health information technology infrastructure,
- authorize the designation of a private entity to certify the implementation of the interoperability standards,
- direct HHS to study how to provide for the harmonization of state laws to promote the secure electronic exchange of health information,
- promote the use of telemedicine, which is especially important in rural areas,
- provide narrow and specific safe harbors from federal self-referral and anti-trust statutes for those who share technology and software for the exchange of health information, and
- permit arrangements between hospitals and physicians that promote implementation of health information technology.
These provisions appropriately focus on developing the network necessary to support the exchange of a patient’s health information in a way that assures privacy and flexibility.
We also approve of the bill’s authorization of pilot tests to demonstrate the effectiveness of value based purchasing (also known as pay for performance) programs. Pilot tests are a commendable first step in this regard. However, value based purchasing depends on the widespread use of interoperable health information technology everywhere in the health care system, including physicians’ offices.
Given the limited dispersion of this technology at the present time, it may be unrealistic to expect that, in two years, it will be feasible to implement any technology-based purchasing program, no matter how effective. Nonetheless, we are eager to work with HHS and ONCHIT to make it possible to implement any purchasing program that proves to enhance health care.
We also support the development of quality standards that have been reviewed and endorsed by the National Quality Forum (NQF) or some other body that is knowledgeable of the health care system but separate from the entity that developed the standards. The Academy considers it necessary to validate evidence-based quality standards by an independent review panel. We are part of a working group (known as the Ambulatory Care Quality Alliance), which was initiated by primary care physicians, purchasers and researchers, including the American College of Physicians, the American Health Insurance Plans, and the Agency for Healthcare Research and Quality. This group has adopted several primary care quality measures that NQF is currently reviewing for rapid implementation and testing. We strongly recommend that any quality measures be evidence-based and subjected to some sort of independent review.
Finally, we would oppose requiring that the three value based purchasing pilot programs – one for Medicare, one for federally qualified health centers, and one for Medicaid – be implemented in a budget-neutral manner. To do so threatens to undermine their purpose. Especially in the context of declining payment rates, if the value based purchasing does not involve added funding, then physicians may find it difficult if not impossible financially to participate. This may not be a formula for improved health care.
Senators, we commend you for your commitment to improving health care and building the technology network necessary to provide that improvement. We are committed to helping you in this important effort.
Sincerely,
Michael Fleming, MD. FAAFP
Board Chair
We also approve of the bill’s authorization of pilot tests to demonstrate the effectiveness of value based purchasing (also known as pay for performance) programs. Pilot tests are a commendable first step in this regard. However, value based purchasing depends on the widespread use of interoperable health information technology everywhere in the health care system, including physicians’ offices.
Given the limited dispersion of this technology at the present time, it may be unrealistic to expect that, in two years, it will be feasible to implement any technology-based purchasing program, no matter how effective. Nonetheless, we are eager to work with HHS and ONCHIT to make it possible to implement any purchasing program that proves to enhance health care.
We also support the development of quality standards that have been reviewed and endorsed by the National Quality Forum (NQF) or some other body that is knowledgeable of the health care system but separate from the entity that developed the standards. The Academy considers it necessary to validate evidence-based quality standards by an independent review panel. We are part of a working group (known as the Ambulatory Care Quality Alliance), which was initiated by primary care physicians, purchasers and researchers, including the American College of Physicians, the American Health Insurance Plans, and the Agency for Healthcare Research and Quality. This group has adopted several primary care quality measures that NQF is currently reviewing for rapid implementation and testing. We strongly recommend that any quality measures be evidence-based and subjected to some sort of independent review.
Finally, we would oppose requiring that the three value based purchasing pilot programs – one for Medicare, one for federally qualified health centers, and one for Medicaid – be implemented in a budget-neutral manner. To do so threatens to undermine their purpose. Especially in the context of declining payment rates, if the value based purchasing does not involve added funding, then physicians may find it difficult if not impossible financially to participate. This may not be a formula for improved health care.
Senators, we commend you for your commitment to improving health care and building the technology network necessary to provide that improvement. We are committed to helping you in this important effort.
Sincerely,
Michael Fleming, MD. FAAFP
Board Chair
