Wednesday, February 11, 2009

$19 Billion For Health IT-Money Well Spent?

Medpage today reported that in yesterday's Senate approval of the stimulus package, that $19 Billion dollars would be allocated to health IT. According to the MedPage report, "The Senate bill allocated about $19 billion to upgrade hospitals' electronic records systems and limited how much an individual hospital could receive to $1.5 million."

Granted, this is only about 2% of the entire stimulus bill, but $19 billion is a lot of money. I am all for improving health IT, but is this where we want to spend the money? I am just a doctor, not a politician, political pundit or economist; so maybe I don't understand the stimulus plan. I thought that the point of the stimulus plan was to create jobs and help people. Since there are several proprietary products on the market, it is unlikely that spending on health IT will create a lot of extra jobs, but rather sell a lot of softwared and some hardware. More importantly, who is the health IT spending helping?

There are 7,569 hospitals in the US. That comes to roughly $250,000 per hospital, though not every hospital gets the same amount (and there is a limit of $1.5 million for an individual hospital). That's a lot of money. Do we really want to give a quarter of a million dollars to each hospital to improve their health IT? Many hospitals already have their own electronic medical records? Do they really even need this? What about the 20% of the hospitals that are for profit, are they getting some of this money?

There is no question that Health IT will substantially improve the quality of care delivery in this country, and in the long term is a worthwhile investment. The real question is how and where should we invest? I would argue that the hospitals are not the best place to go. Fortunately, most Americans with health problems are not in the hospital. Certainly hospitalized patients comsume more health care dollars, but there is no good evidence that health IT actually saves money. Would it not be better to invest in Health IT that actually keeps patients out of the hospital? In addition, as mentioned, many hospitals already have an electronic medical record/electronic ordering, whereas most practicing physicians (especially primary care) do not have an EMR. Would it not be better to give $85,000 to each primary care physician to set up his or her own EMR? Better yet, use the money to come up with a system that actually works, is easy to use and distribute, improves quality of care for all and decreases costs?

Health IT is important, and should be an important part of health care reform. However, giving $19 Billion directly to hospitals to beef up systems that many already have is not money well spent.


Anonymous said...

A few thoughts:

1) You are right about fund allocation. Must be watched, there will be gaming.

2) If you are going to be EBM based, while there is a paucity of data for sure, cant say this wont lead to jobs and innovation IF spend correctly. I am less sanguine. Lets see

3) One third of health care dollars are spent on inpatient setting, from which big ticket tests are ordered. Duplication of these studies during other admits at other institutions is expensive. Interoperability key. I disagree. Wire hospitals first, both for above and also economies of scale.

Dr. Matthew Mintz said...

You are correct that duplication is expensive and interoperability is key. However, it's not clear to me that this is what the money is going to be spent on. In addition, many expensive tests like CT scans and MRI's are done outside the hospital. Thus, integration of these outside studies are key as well. If money goes directly to the hospitals without some stipulations on how the money is spent (i.e. must go to interoperability), then I doubt hospitals will do this on their own.
Also, the reak way to cut down on testing is malpractice reform and not health IT

Anonymous said...

No one is thinking of the long term in any EHR discussions. For this gain in accuracy and decrease in some cost as with anything there is a price. Everyone is looking only at the deployment price.

The ultimate problem is like that of the US highways, maintenance.

Even if they can be deployed in pieces the 'real' goal is at least regional respositories if not a national repository.

Securely adding, maintaining, and retrieving that data across every person in the US across a lifetime will have a continual high cost.

Also if they become relied upon to be accurate and the single point of data, there will not be any backup if they are not available. It just will not happen. On-line backup and disaster recovery will be not cost feasible.

Corrections to records will be like your credit records; impossible.

This system as it moves to regional or national will be like no other data system ever deployed. Tougher than IRS, Banking, Airline, to keep on-line, up to date, quick responding, and secure.

$19 billion is a drop in the bucket. Who keeps paying for it when the average person can not even afford the health care of today.