Leavitt Letter Suggests Change in Administration’s Position on HIT Mandates


If the Dec. 4 letter to Congress from Health and Human Services Secretary Mike Leavitt that calls for greater Medicare incentives for electronic health records (EHRs) seems like it came out of nowhere, that’s because it practically did.

The Bush administration has opposed any kind of mandates in health-IT almost since Day 1 — or at least since HIPAA — but the Leavitt letter comes closer to a mandate than anything we’ve seen before. The secretary asks Congress to include EHR incentives in any bill to roll back the planned 10 percent Medicare physician fee cuts for 2008, including giving the Centers for Medicare and Medicaid Services authority to require ePrescribing at some point in the future.

“Physicians who do not adopt appropriate, available technology should receive a lower payment than those who do,” Leavitt wrote.

Bombshell? Perhaps. “To me, the push for health-IT has moved from being a trickle to a tsunami,” says Lillee Gelinas, vice president and chief nursing officer of VHA Inc. (Irving, Texas).

At the Nov. 13 meeting of the American Health Information Community (AHIC) in Chicago, Leavitt asked the advisory board’s EHR workgroup to develop a recommendation on EHR adoption within 30 days. He had one in half that time.

“I’ve never seen the political process work so quickly,” says Gelinas, who co-chairs the EHR workgroup with Jonathan Perlin, senior VP for quality and chief medical officer of hospital chain HCA and former boss of the Veterans Health Administration. “Jon Perlin and I worked like madpeople behind the scenes.”

After they delivered the recommendation to Leavitt, the secretary convened a first-ever special AHIC meeting by conference call on Nov. 28 — just 15 days after the Chicago meeting — and the board quickly adopted the proposal. Leavitt drafted the letter and delivered it to Senate Finance Committee chairman Max Baucus of Montana and ranking Republican Charles Grassley (Iowa) the following week.

“It shows [that] when there’s linkage and alignment, things can get done,” Gelinas tells Digital HealthCare & Productivity.

Now it’s up to Congress to act. Anyone who follows health-IT knows that that’s far from a sure thing.

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