Executive order supports HIT and quality measures

All federal agencies and their contractors that administer or sponsor a federal health care program must make information about the quality and price of health care available to their beneficiaries, enrollees and providers, according to an executive order signed by President Bush on Aug. 22. The executive order also requires that the agencies use interoperable health information technology and standard quality measures as well as develop and identify practices to promote high-quality care.

The four specific agencies affected oversee almost a quarter of Americans covered by health insurance: Health and Human Services oversees Medicare, the Department of Defense oversees TRICARE for the military, and the Department of Veterans Affairs and the U.S. Office of Personnel Management both oversee the Federal Employees Health Benefit Program. In a panel discussion before signing the order, President Bush explained that the federal government spends a lot of money within Medicaid and Medicare, veterans’ benefits and Department of Defense.

“And one of the initiatives [Health and Human Services Secretary] Mike [Leavitt] is now going to undertake is, say, in order to do business with the federal government, you’ve got to show us your prices, and you’ve got to help us develop a qualitative standard so the people that we’re trying to help know what they’re getting,” Bush said.

The goal of these initiatives is to make cost of care and quality transparent—using market strategies that dictate success for well-made, well-priced products—so that ultimately costs for health care drop and quality rises. The agencies have until Jan. 1, 2007 to comply with the new measures.

The concept of health transparency empowering consumers to shop around for bargain health care to lower prices and improve quality is key in the Bush administration’s health care policy. One component the administration supports is the expansion of health savings accounts for patients. HSAs are high-deductible tax-free savings accounts in which an individual invests to cover medical costs. That means that a large chunk of initial costs comes directly from the patient’s pocketbook until costs reach a catastrophic level and the insurance company steps in. Bush is counting on the relationship between thrifty Americans and their wallets to inspire cost-conscious spending.

A fact sheet from the White House supports giving consumers information about their health options, the quality of doctors and hospitals in their areas and the cost of procedures, to help make those informed health care decisions. This information will come from a variety of potential sources, the fact sheet reports, including insurance companies, employers, and Medicare-sponsored Web sites. However, recent reports find that health transparency has been largely impeded by private health insurance companies unwilling to release specific claims information, physicians who cannot accurately report health plan reimbursement and the government not reporting prices or quality under the terms of contract confidentiality.

For physicians who care for beneficiaries of federal health care programs, it is unclear how mandated transparency and interoperability will affect their practices. A press release from HHS states that the executive order should help support doctors and hospitals in providing high quality care and avoiding excess health care costs, but doesn’t give specific reporting methods. This means that many providers will have to develop their own tactics to report to CMS.

“Basically, if [providers] want to participate in the federal programs, they will have to comply with the new provisions—interoperability and transparency,” said Doreen Bell, an AAFP government relations representative. “They’ll have to start thinking about how to disclose this information, which is going to be more complicated.”

While the executive order is only binding for the four federal programs, the Bush Administration hopes that those in the private sector will see this collaboration of agencies as a positive demonstration project and adopt some of these measures to improve health care overall. Bush supports this teamwork and explained that the order “basically commits the federal government to work with state and local docs and hospitals to lead the way and be a part of this new movement about transparency in pricing and quality.”