Government Relations Update

Administration Acts on Health Information Technology (HIT)

October 10, 2006

The Bush Administration is a strong proponent of rapid adoption of health information technology and during August took several actions to expand the use of HIT in the private sector. These administrative actions are in addition to congressional legislation, which advanced during July and brought in the debate the problem protecting personal health information privacy in a national HIT system. See NASW’s website for a briefing on the federal legislation: (S. 1418/HR. 4157)

Executive Order Released

On August 22, 2006, President Bush Signed an Executive Order to “increase the transparency of America's health care system” and “empower Americans to find better value and better care.” According to the order, “To spend their health care dollars wisely, Americans need to know their options in advance, know the quality of doctors and hospitals in their area, and know what procedures will cost. When Americans buy new cars, they have access to consumer research on safety, reliability, price, and performance - and they should be able to expect the same when they purchase health care.” The order requires health care programs and agencies administered or sponsored by the Federal government to promote quality and efficient delivery of health care through the use of health information technology, “transparency” regarding health care quality and price, and improved financial and quality incentives for program beneficiaries, enrollees, and providers. The order also makes purchasing information available to beneficiaries, enrollees, and providers in a readily useable manner and in collaboration with similar initiatives in the private sector and non-Federal public sector.

The Executive Order directs Federal agencies that administer Federal health insurance programs including Medicare, Medicaid, and the veteran’s health benefits to:

1. Increase Transparency in Pricing. Directs Federal agencies to share with beneficiaries’ information about prices paid to health care providers for procedures. Each agency shall make available to its beneficiaries or enrollees the prices that it, its health insurance issuers or its health insurance plans pay to providers for procedures. Agencies must develop information on the overall costs of services for common episodes of care and treatment of common chronic diseases.
2. Increase Transparency in Quality. Directs Federal agencies to share with beneficiaries information on the quality of services provided by doctors, hospitals, and other health care providers. Each agency must implement quality measurement standards for the services furnished by health care providers to beneficiaries or enrollees of Federal health care programs. An agency meets this requirement if it participates in the aggregation of claims and other appropriate data for the purposes of quality measurement.
3. Encourage Adoption Of Health Information Technology (HIT) Standards. Directs Federal agencies to use improved HIT systems to facilitate the rapid exchange of health information. All agencies must use health information technology systems and products that meet "recognized interoperability standards" when they implement, acquire, or upgrade health information technology systems for the direct exchange of health information between agencies and with non-Federal entities. Recognized interoperability standards mean such standards recognized by the Secretary of HHS on the date of implementation, acquisition or upgrade. In contracts or agreements with health care providers, health plans, or health insurance issuers. 
4. Provide Options That Promote Quality And Efficiency In Health Care. Directs Federal agencies to develop and identify approaches that facilitate high quality and efficient care. Each agency must develop and identify for beneficiaries, enrollees and providers approaches that encourage and facilitate the provision and receipt of high-quality and efficient health care. These approaches may include pay-for-performance models of reimbursement. Agencies satisfy this requirement if they make available "consumer-directed" health insurance products.

The Bush Administration’s plan for health system reform would position consumers to receive information through a “collaborative process.” The Federal government will work to build on efforts by quality alliances that include a broad range of health care stakeholders to improve quality and cost information. Measures of quality at the provider and health plan level will be developed from private and government sources and will not involve developing or releasing data at the individual patient level. Participation in this process in each area will be governed by various regional stakeholders, including local providers, employers, and health plans and insurers. Consumers will be able to access information from a variety of potential sources, including insurance companies, employers, and Medicare-sponsored websites.

The President’s August 22nd address that accompanied the order also outlined his larger health agenda to make care more affordable by speeding the adoption of HIT, allowing small businesses to form Association Health Plans (AHPs); passing medical malpractice legislation, and expanding individual and employer adoption of Health Savings Accounts (HSAs).