For the last few weeks, there's been a lot of crunching of the
numbers and reading of the fine print, as people try to
figure out how the health IT federal stimulus money is going to
affect the Massachusetts health care system.
At this point, the picture is far from clear. Governor Patrick
has said the total stimulus funds coming into the state for all
purposes will be "between $6 billion and $9 billion." That's a
broad range. But for health IT, it's possible to provide a little
more precision about what is coming.
The funds will come in two pools:
Loans and grants for a smaller number of
eHealth projects before implementation. Most of
these loans and grants will be channeled to state-level public
agencies through a new agency of HHS, the Office of the National
Coordinator (ONC). These total $2 billion nationwide, of which an
estimated $40 million would be for Massachusetts. (Massachusetts
estimate is from the Mass. Health Data Consortium.)
Incentive payments to physicians and
hospitals after they implement electronic health
records. This will be about $36 billion nationwide, of which $727
million could be ticketed for Massachusetts. (Massachusetts
estimate is from the Mass. Health Data Consortium.)
The Massachusetts Wish List
Several weeks before the bill was passed, the Patrick
administration formed 10 task forces to develop wish lists for the
federal funds. The report covers education, energy transportation,
information technology, and more.
Download the Task Force
Reports |
The report identifies four eHealth categories:
Ambulatory Electronic Health Records:
Estimated cost - $340 million. To deploy EHRs in 13,000 individual
physician practices, out of an estimated total 14,000. The report
says this project would create new 850 jobs.
Computerized Physician Order Entry: Estimated
cost - $125 million. To deploy CPOEs in 63 acute-care hospitals
that don't have one, or where they're not fully implemented. The
report says this project would create 275 new jobs.
Community Health Center EHRs: Estimated cost
- $13 million. For the 12 community health centers that don't have
an EHR, or where one is not fully implemented. The report says this
project would create 32 new jobs.
State-Level Health Information Exchange:
Estimated cost - $35 million. To support the secure sharing of
patient information through a state health care data warehouse.
Patient data would be de-identified for "population measurement,
bio-surveillance, and quality/outcome measurement." The report says
this project would create 96 new jobs.
The first thing that may strike the reader is that while the
state report lists $340 million worth of EHR projects, MHDC
estimates that only $40 million would be available in Massachusetts
upfront for all eHealth projects, of which EHRs
would only be a portion. Further, the California Health Care
Foundation believes that most of the upfront grants will be
directed to health information exchanges (HIEs), not to individual
EHR installations.
So if the MHDC estimate is accurate, there will not be much
money to subsidize individual EHRs before implementation. The most
realistic expectation for physicians is to plan for federal EHR
assistance after implementation, no sooner than 2011.
It's probably best to read the state report as a comprehensive
list of the universe of eHealth projects needing funding in
Massachusetts, whether from public or private sources.
The federal government has a lot of work to do. It must now
flesh out how and when the money will flow. We'll provide updates
as they become available.
For more background on the incentive, loan and grant programs,
click here.
Sources
Health Information Technology for Economic and Clinical Health
(HITECH) Act, a component of the American Recovery and
Reinvestment Act of 2009. Full legislative text. Enacted
February 17, 2009. (.pdf, 37 pages,113 kb)
Massachusetts Health Data Consortium. "Understanding the HIT and
HIE Provisions in the Stimulus Bill." Presented March 4, 2009. No
digital version available.
Commonwealth of Massachusetts.
Mobilization for Federal Economic Recovery Infrastructure
Investments - Task Force Reports. Published February 2009.
(.pdf, 192 pages, 1.5 mb)
California Health Care Foundation. An
Unprecedented Opportunity: Using Federal Stimulus Funds to Advance
Health IT in California. Published February 2009.
