Health IT, Primary Care Come Out Ahead in Massive Stimulus Bill

Congress has approved a $789.5 billion economic stimulus package that will strengthen the nation's health care infrastructure by making substantial investments in an array of health-related programs and provisions, including health information technology, or HIT, education and training programs for primary care physicians, and comparative effectiveness research.

The American Recovery and Reinvestment Act of 2009, or ARRA, represents an acknowledgement on the part of the Obama administration and most congressional members that the economy and health care are inextricably linked and that sustained economic growth depends on a well-functioning health care system, said AAFP President Ted Epperly, M.D., of Boise, Idaho.

"The stimulus package demonstrates that the Obama administration and Congress believe that primary care and the patient-centered medical home are part of the answer to America's future health care system," he said.

The measure, which President Obama is expected to sign, provides $19 billion for HIT -- $17 billion for incentives to encourage the adoption of HIT by Medicare and Medicaid providers during the next five years and $2 billion in immediate funding for the nation's HIT infrastructure. (Editor's Note: President Obama signed the bill into law on Feb. 17.)

The bill also allocates $500 million in additional funding for health care workforce programs, including primary care training grants. This will provide substantial increases for these programs, which historically have been underfunded.

Additionally, the measure allocates $1.1 billion for comparative clinical effectiveness research, including $300 million for the Agency for Healthcare Research and Quality and $400 million each for HHS and NIH to conduct this research.

The stimulus package addresses many of the issues and concerns long championed by the AAFP, such as the need to help physicians adopt HIT, greater investment in the primary care physician workforce and more money for comparative effectiveness research and prevention efforts, according to Epperly.

In fact, AAFP officials met with members of Obama's presidential transition team late last year to express support for these issues. In December, AAFP Board Chair Jim King, M.D. of Selmer, Tenn., sent three separate letters to (then) President-elect Obama, urging the administration to increase funding for primary care services and programs to help physicians adopt HIT as part of any economic stimulus package.

"It is very gratifying to know that our voice is being listened to and that the administration and Congress believe our needs are aligned with what needs to be done to change our health care system," said Epperly.

The HIT provisions in the stimulus package employ a combination of incentives and penalties to encourage the adoption and use of HIT by physicians participating in Medicare and Medicaid programs.

The measure provides incentives of up to $15,000 for using HIT in 2011 and a maximum of $12,000 the following year. The incentives fall to a maximum level of $8,000 in 2013, followed by decreases to $4,000 in 2014 and $2,000 in 2015.

The federal government will not provide incentives after 2015, but in an effort to encourage early adoption, the measure provides as much as $18,000 in incentive payments for providers who first use HIT in 2011 or 2012, for a maximum amount of $44,000 during a five-year period. In addition, providers in rural health professional shortage areas, or HPSAs, will have their incentive payments increased by 25 percent.

But for providers who fail to adopt HIT before 2015, the measure cuts Medicare payment rates by 99 percent for 2015, 98 percent for 2016 and 97 percent in 2017. The payment rates continue to fall, but at a slower rate after 2017.

The ARRA also provides $300 million for the National Health Service Corps and $200 million for primary care and other health care professions trained through Titles VII and VIII of the Public Health Service Act. This includes primary care medicine and dentistry programs, public health and preventive medicine programs, and the scholarship and loan repayment programs funded under Titles VII and VIII.

"This is yet another signal that the administration and Congress support the training of primary care physicians for this country," said Epperly.

Provisions to strengthen the nation's health care safety net also are included in the legislation. For example, the bill provides an estimated $86.6 billion during the next two years in additional federal matching funds to help states maintain their Medicaid programs amid massive state budget shortfalls. It also provides $24.7 billion to help unemployed workers retain their health care benefits.