Leaders ask for IT funding fix

Recognizing the importance of improved technology, notably, adoption of electronic health records (EHRs), to meeting the nation's goals of improving care, eliminating errors, and reducing costs, many healthcare providers celebrated the announcement of major information technology funding incentives provided by the American Recovery and Reinvestment Act of 2009.

Within the ARRA, the $50 billion Health Information Technology for Economic Clinical Health (HITECH) Act encourages targeted development of healthcare technology infrastructure with a three-part program that includes:

• Standards and certification criteria for creation of interoperable systems;

• Grants, loans, and incentives to encourage adoption and “meaningful use” of certified electronic health records; and,

• Improvements to information privacy and security rules to encourage widespread adoption and use of health IT infrastructure.

Early on, however, behavioral health technology advocates noted a problem: The HITECH Act's technology incentives were offered only to “eligible professionals” in the behavioral health field, specifically non-hospital based physicians and nurse practitioners. Many large behavioral health organizations-notably inpatient psychiatric hospitals, addiction treatment centers, and community behavioral health centers-would not qualify for organization-wide funding under the definition of “hospital” used in the HITECH Act.

Immediately, advocates recognized that this legislative omission would, if allowed to stand, effectively torpedo the levels of funding required to acquire, adopt, and achieve meaningful use of EHRs and other vital health IT infrastructure. The omission would mean that the only incentive funds available to behavioral health organizations would be those assigned by their eligible provider physicians and nurse practitioners. These providers, who would have to use certified EHRs to meet “meaningful use” criteria to qualify for funds, could realize up to $63,500 in Medicaid incentives over a six-year period, from October 2011 to October 2016.

“While $63,000 per provider sounds like a lot of money, you have to look at the structure of a typical behavioral health organization,” says Kevin Scalia, executive vice president for corporate development at Netsmart Technologies (Great River, NY). “In a community behavioral health center, you might have one MD, several psychologists, some clinical social workers, and many case mangers and counselors, all of whom require access to information technology. That means equipment, networking, training, and support for ongoing use.” Scalia adds that while larger facilities, including addiction treatment centers and inpatient psychiatric hospitals, would have more eligible practitioners, the ratio of non-eligible clinical staff puts them in the same funding predicament.

Months ago, Scalia began networking with members of Congress, behavioral health leaders, and key HHS leaders to devise a solution. Backed by industry and legislative input, he formed a small group of industry leaders into a National Advocacy Team for the behavioral health industry. The team includes:

• Denny Morrison, CEO of Centerstone Research Institute (Bloomington, Ind.);

• Mark Covall, CEO of the National Association of Psychiatric Health Systems (Washington, DC);

• Ron Manderscheid, Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors (Washington, DC); and,

• Chuck Ingoglia, vice president for public policy at the National Council (Washington, DC).

Together, this team outlined a proposal for legislation that would:

• Add private and public psychiatric hospitals, community mental health centers, and substance use treatment facilities to the list of Medicaid-eligible facilities that can qualify as organizations for HITECH incentives similar to those offered to hospitals.

• Add clinical psychologists and clinical social workers to the list of “eligible professionals” who can, by meeting requirements for meaningful use of an EHR system, qualify for up to $63,750 in HITECH incentives-the same level of incentives now available to physicians and nurse practitioners.

• Authorize $15 million in HIT grants to CMHCs, similar to those now available to federally qualified health centers (FQHCs), to drive adoption of additional infrastructure, including the development of health information exchanges (HIEs), which will be needed to support the transmission and exchange of interoperable health information between providers.

Many large behavioral health organizations would not qualify for funding under the definition of “hospital” used in the HITECH Act.

According to Scalia, the draft bill, which will be sponsored by Rep. Patrick Kennedy (D-R.I.), is expected to be introduced in the House of Representatives sometime in April.

Behavioral Healthcare 2010 April;30(4):8-9