Despite clearing both the House Ways and Means Committee and the House Energy and Commerce Committee in June, health information technology (Health IT) legislation (H.R. 4157) has run into serious delays that threaten final action on this important legislation by the 109th Congress. Healthcare Roundtable members and others interested in this legislation are urged to contact their Members of Congress seeking their help in obtaining prompt consideration of the legislation by the full House of Representatives so that H.R. 4157 can be sent to conference with the Senate as soon as possible.

One snag has been a June 15, 2006 letter from the Congressional Budget Office (CBO) to Congressman Charles Rangel (D-NY), the ranking Democrat on the Ways and Means Committee, warning that the legislation could produce increases in Federal spending. In addition, jurisdictional disputes between Ways and Means and the Energy and Commerce panel are proving more difficult to resolve than previously expected.

The CBO letter focuses on certain exemptions that the legislation would create for donations of health IT that might otherwise be subject to civil monetary penalties, criminal penalties or sanctions for violating the prohibitions on certain physician referrals - the so-called "Stark law." While direct links between the IT "gift" and referrals from the recipient to the donor would still be prohibited under H.R. 4157, CBO believes that such conditions would be implicit. Consequently, CBO told Mr. Rangel that it estimates that, in the aggregate, "such donations by entities other than hospitals, group practices, Medicare Advantage plans, and prescription drug plans would lead to an increase in the volume of services that Medicare and state Medicaid programs pay for, thus increasing costs."

While the CBO letter has been problematic, differences of opinion between the heads of the two jurisdictional committees (Ways and Means Chairman Bill Thomas (R-CA) and Joe Barton (R-TX), the head of Energy and Commerce) are also proving more difficult to resolve than anticipated. Specifically, modifications to the Health Insurance Portability and Accountability Act (HIPAA) to preempt state privacy laws within three years, contained in the Ways and Means bill but dropped by Energy and Commerce, appear to be at the heart of the dispute.

The other bone of contention is the update of the International Classification of Diseases codes from ICD-9, with its 24,000 codes, to ICD-10, with about 200,000. Transition costs are estimated to be as low as $425 million or as high as $14 billion, depending on whose side you take. The Ways and Means version would require the update to be completed by October, 2009; the Energy and Commerce Committee's bill deleted this provision.

Pressure is building on the two committee chairs to reach an accord. Majority Leader John Boehner (R-OH) has reportedly met with both Thomas and Barton to urge a compromise, and former House Speaker Newt Gingrich is said to have sent a letter to them saying that it would be a "disaster" if the health IT bill died. According to rumors, a deal may be in the works in which Thomas would agree to replace the state privacy laws preemption with a study of the privacy issues involved, and Barton would accept a date certain for implementation of the ICD-10 codes, but one that is further out in time than October, 2009.

However, any such compromise must be reached soon if a final agreement is to be hammered out with the Senate -- which unanimously approved its version of Health IT (S. 1418) in November, 2005. With Congress scheduled to adjourn the first week in October, only about 8 weeks of legislative session remain; given the current practice of the Congress to do no work on Mondays and Friday, that leaves about 20 legislative days left in the 109th Congress.

Therefore, passage of H.R. 4157 before the House adjourns for the month of August is critical to the enactment of any Health IT legislation in 2006.

Below you will find links to a number of items dealing with the issue of health IT that you may find helpful in preparing your communication with Members of Congress. You do not need to take a position on the merits of H.R. 4157 as approved by either House Committee, nor on any possible compromise. You do not need to address the implications of the CBO letter. Your message should simply be that the full House must be permitted to consider a Health IT bill before the August recess begins.

Because letters take several weeks or more to actually reach a Congressional office due to post-9/11 security measures, you should either fax or e-mail your correspondence. For specifics on how to do so, check out your Members' websites. The Capitol switchboard can also connect you directly to specific Member offices; the number is 202-224-3121. In addition, since most Members of Congress will be in their Congressional districts during the August recess, you should also consider making an appointment to present your views in person.

Finally, please be sure to share a copy of your correspondence with the Roundtable.

• GAO Report: "Information Technology: Benefits Realized for Selected Health Care Functions"
• National Governors Association: "A National Health Care Innovations Program"
• Annals of Internal Medicine: "The Costs of a National Health Information Network"
• The Lewin Group HIT Leadership Panel Final Report, March 2005
• Governing.com: "The Great eHealth Hope"
• Rand Corporation: "Can HIT Lower Costs and Improve Quality?"
• Connecting for Health: "Common Framework: Resources for Implementing Private and Secure Health Information Exchange"
• Commonwealth Fund: "Health Information Technology: What is the Federal Government's Role?"