April 2, 2012 By Wayne Hanson
Late last month, the U.S. Supreme Court took arguments on the individual mandate for the Affordable Care Act (ACA). The mandate would require most Americans to purchase health insurance or face a financial penalty.
Many observers were shaken by what they heard during the oral arguments. CNN reporter Jeffrey Toobin said the Supreme Court session was a “train wreck for the Obama administration” and predicted that “this law looks like it’s going to be struck down” because of harsh questions directed to the administration’s attorney. “All the predictions — including mine — that the justices would not have a problem with this law were wrong,” said Toobin.
The Supreme Court’s decision is not expected until summer, but uncertainty has spiked as to what the effects might be if the law is upheld, struck down, or the individual mandate is overturned and the rest of the act allowed to stand.
Regardless of what the Supreme Court decides, most major health IT initiatives are not likely to be affected directly, although smaller ones may suffer. The HITECH Act, for instance — designed to “promote the adoption and meaningful use of health information technology” — is part of the American Recovery and Reinvestment Act of 2009, not the ACA. It requires implementation by 2014 of specific privacy and security standards for electronic health records.
The ACA’s Prevention and Public Health Fund (PPHF), however, may suffer if the ACA is overturned, and is of particular interest to local government health organizations. “It holds great promise to improve the capacities of local health departments,” says the act, “to protect their communities from health threats through the use of technology.”
Eli Briggs, director of government affairs for the National Association of County and City Health Officials (NACCHO), said the PPHF would substantially move the focus of public health to prevention and provide mandatory funding for it. “If we can prevent diseases like diabetes and heart disease that are so costly,” she said, “then we can save money. What a lot of health departments do is work on programs to reduce smoking or get people more physically active and show how they can be healthier. So that’s why that fund has been a big focus for us.”
While Briggs is enthusiastic about prevention, she’s less certain about the technology component. “The fund has the capability of being used for anything that comes under the broad category of prevention in public health,” she said, suggesting that IT may be steered toward disease surveillance, data collection and analysis. “So our members are hopeful that as the health-care system capacity increases, that public health will be able to receive data from health-care providers and pick up on disease more quickly — if there’s an outbreak of a particular disease they’ll be able to see those spikes more quickly.”
Briggs did say that some health departments are preparing billing systems that they didn’t have before, in anticipation of ACA implementation. “They will be able to bill Medicaid and some of the new insurance products that are going to be out there,” she explained. “With people having more insurance, health departments may want to bill for immunizations where before it was just a cost. And now they will need to get reimbursed for those services.”
A NACCHO white paper on implementation of the ACA also addresses the technology issue: “As use of health information technology (HIT) becomes more widespread by clinical providers, LHDs [local health departments] have the opportunity to maintain and enhance their role as health data and information repository for the community and analyze available data. However,” continues the white paper, “this will require greater adoption of HIT by LHDs than is currently the case. LHDs should adopt electronic health records and work to expand health information exchange between LHDs and health-care providers to meet the requirements of the ACA, reduce administrative costs, prevent costly and unnecessary duplications of service, and improve health outcomes. NACCHO has advocated for further support from the federal government, as is currently the case for physician practices and hospitals, to foster further adoption of HIT by LHDs.”
Another technology-related aspect of health data exchange is the transition to ICD-10, a system of medical codes already used in other countries for the exchange of medical data. “Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA),” said HHS in a release, “will be required to use the ICD-10 diagnostic and procedure codes.” The February release, however, announced that the Oct. 1, 2013 implementation deadline was postponed, and that a new deadline would be announced at a later date.
Marie Fallon, CEO of the National Association of Local Boards of Health summed up, in an email to Government Technology, that organization's support for the ACA: “Local and county governments absorb significant medical costs under current circumstances. For example, health coverage of the uninsured or uninsurable (pre-existing conditions, or marginally employed or unemployed, or homeless or otherwise disenfranchised) who currently do not seek health care except when health problems are advanced, and whose medical expenses are thus extreme -- and whose health costs must be absorbed by local health departments, or county general assistance -- can be of great expense to small government. This socio-economic-health care problem is exacerbated by the current economic climate that further marginalizes those in the lowest income brackets. A single case of TB or similar malady can cost a local government entity many thousands of dollars, expense that could have been covered by the ACA.”
At Issue: If the Supreme Court strikes down part or all of the Affordable Care Act, how do you think it would impact local health-care initiatives centered on information technology? Leave your comments below.
This Digital Communities white paper highlights discussions with IT officials in four counties that have adopted shared services models. Our aim was to learn about the obstacles these governments have faced when it comes to shared services and what it takes to overcome those roadblocks. We also spoke with several members of the IT industry who have thought long and hard about these issues. The paper offers some best practices for shared government-to-government services, but also points out challenges that government and industry still must overcome before this model gains widespread adoption.