The Behavioral Health Information Technology Coalition participated in briefings this week in Washington to encourage the passage of legislation that would provide incentives for behavioral health providers to adopt EHRs. Senators Sheldon Whitehouse (D-R.I.) and Rob Portman (R-Ohio), co-sponsors of the Behavioral Health Information Technology Act (S. 1517/S.1685), hosted the event.
According to coalition member Rebecca Smith, MCSE, chief information officer for Henderson Behavioral Health in Ft. Lauderdale Fla., the key message to lawmakers was that behavioral health providers were left out of the federal EHR incentive program in 2009, and that was a mistake. The federal program provides funds to other types of providers to adopt EHRs, if they attest to what’s known as “Meaningful Use”—in other words, prove that they are working toward interoperable data sharing.
“If you look at the statistics nationally, most of the cost of healthcare is from individuals who have co-occurring behavioral health and physical health disorders,” Smith says. “It makes no sense not to include behavioral health into the mix.”
Henderson has an EHR and recently began sharing patient data with a local hospital, Memorial Healthcare, when a patient is referred from the hospital emergency department to Henderson. It’s significant because the two providers are able to use standard data protocol to exchange information, even though they have two separate EHR systems.
“There’s not a need to rewrite or create new interoperability standards because in Meaningful Use Stage 1, they started to do that,” she says. “Those standards are what we use at Henderson Behavioral Health to create a direct connection with Memorial Healthcare.”
Smith says Henderson’s data exchange is proof that behavioral health providers can achieve interoperability and hit Meaningful Use targets. Coalition members aimed to make lawmakers aware of the potential that IT has for providers that treat addiction and mental health disorders.
“We got a positive reaction, and I feel encouraged,” she says.
Cost of the legislation
The IT coalition has long supported the Behavioral Health Information Technology Act in the Senate and the companion bill in the House (H.R. 2957), sponsored by Rep. Tim Murphy (R-Pa.).
“While the environment in Washington has a lot of partisan warfare—particularly on healthcare policy—
this legislation on both the House and Senate side enjoys wide bipartisan support,” says Alfonso V. Guida, president of Guide Consulting Services, a Washington lobbyist.
According to Guida, if EHR incentives are offered to behavioral health providers, it will create a new cost for the federal government. However—as is typical with proposed legislation—those costs would be offset by two counterbalances in the bills.
The nuances are complex, but in general, the counterbalances aim to reduce defensive medicine and to some degree reduce spending for Medicare and Medicaid. First, the legislation permits a provider or IT vendor to file a clinical adverse-event report with a safety organization without the risk of the report being used in a court case against the provider. Additionally, it also provides for a safe harbor that would protect certain medical records with Meaningful Use attestation from being accessed by plaintiffs in lawsuits unrelated to those specific patient records.
“The purpose of that is to provide incentives to adopt EHRs,” he says. “Some providers are not adopting EHRs because of legal liability concerns.”
What’s interesting is that the Murphy bill in the House (H.R. 2957) has the same counterbalances as the Senate proposal (S. 1517/S.1685).
“We think the offset in the Portman and Murphy bills easily produces $3 billion in savings to the federal government over 10 years,” Guida says.
Hope for 2015
Of course, all legislative proposals in Congress expire at the end of the year and will have to be reintroduced in the 2015 session. Guida says the outlook is genuinely positive that Senate bill will be reintroduced—possibly as part of a new “doc fix.” The doc fix bills protect Medicare physicians from incremental payment cuts until a more permanent Medicare payment solution is created and are likely to pass.
“That’s not the only legislative vehicle, but it’s the most attractive one,” he says.
In the event a doc fix doesn’t provide an opportunity, Guida says there will be budget reconciliation bills and other changes to Medicare and Medicaid that could carry the behavioral health IT proposals.
Additional participants at the Congressional briefings included:
- Joel White, Executive Director, HIT NOW Coalition
- Dr. Tom Doub, CEO, Centerstone Research Institute (CRI), Nashville, TN
- Michael Lardieri, LCSW, AVP Strategic Program Development, North Shore LIJ Health System, Zucker Hillside Hospital, Glen Oaks, NY