FP Testifies Before House Subcommittee on Health IT Issues, Praises Bill to Help Physicians Purchase Health IT Systems

As many primary care practices face declining payments and higher operating costs, it becomes increasingly difficult for them to access capital to invest in health information technology, or health IT. An initiative that would allow physicians to secure loans through commercial vendors to purchase health IT systems and give them a deferral period to pay back the loans would help, according to FP Sterling Ransone, M.D., of Deltaville, Va., who testified before the House Small Business Committee's Subcommittee on Finance and Tax here on July 23.

Ransone testified in favor of the Small Business Health Information Technology Financing Act, or H.R. 3014, (at the THOMAS Web site, type "H.R. 3014" in the search box after selecting "Bill Number.") which would provide loan guarantees for the acquisition of health IT by physicians in solo and small-group practices and allow for a loan repayment deferral period of one to three years.

Ransone told subcommittee members that everyone benefits from health IT systems. Investment in such systems at the practice level is critical to improving patient care and reducing costly medical errors; these systems also help patients manage their care better. However, he stressed, physicians currently bear the costs of acquiring and implementing health IT systems at the same time they are experiencing dwindling payments and rising operating costs.

"Right now, about one-half of family physicians are using electronic health records (EHRs), and we're proud of that fact," said Ransone. Based on an August 2008 AAFP survey, however, the other half of FPs indicate that cost is the reason they are not purchasing health IT systems.

According to Ransone, H.R. 3014 would help physicians adopt health IT while serving as a welcome adjunct to provisions in the newly enacted American Recovery and Reinvestment Act, or ARRA, of 2009, which provides a total of $19 billion for health IT.

"The AAFP worked closely with Congress to craft the recovery act provisions on (health) IT," said Ransone. "The law makes an unprecedented investment in (health) IT. It reflects an understanding of (health) IT as critical in any reformed health care system."

Ransone pointed out, however, that the recovery act does not provide upfront capital for physicians seeking to purchase health IT systems. H.R. 3014 would help fill that void by providing loan guarantees for physicians and practices to purchase health IT systems.

"We appreciate that (H.R. 3014) recognizes that solo, small- and medium sized-physicians offices still find it difficult to afford HIT," Ransone said.

Ransone told the subcommittee that a physician friend of his in a small practice in an underserved area undertook a serious review of available EHR systems to find one that was affordable and appropriate for his practice.

"Unfortunately, despite his due diligence, he came to the reluctant conclusion that, as a small business owner, he simply could not afford to make the investment," said Ransone. "My friend is precisely the type of small practice this bill would target."

He also raised questions about the future of health IT. For example, H.R. 3014 provides capital outlays for health IT, but it does not provide funds for ongoing management and maintenance of health IT systems.

"Consulting, training and workflow redesign must be considered in addition to hardware and software issues," he said. "These will be ongoing costs for each physician."

Moreover, noted Ransone, current health IT systems lack interoperability standards, which creates another barrier for physicians. Physicians who make an initial investment in a health IT system could discover that their system cannot communicate with other systems or providers. Ransone also expressed concerns about some of the health IT provisions in the ARRA. "The specifics of the recovery act are still unclear," he said, especially the definition of "meaningful use."

In response to a question posed by Subcommittee Chair Kurt Schrader, D-Ore., Ransone noted that health IT requires a steep learning curve. Most practicing physicians were trained using paper-based prescribing and record-keeping processes; so the adoption of a health IT system is tantamount to putting a "computer between you and the patient," Ransone said.

"You need to learn to use it, especially people like me who are not touch typists," he said. "There is an incredible loss of productivity for the first three months."

Ransone said it took his practice about two years to achieve the same level of productivity it had before implementing health IT. This makes the loan deferments contained in H.R. 3014 critical, he said.