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doi: 10.1097/01.NT.0000347495.38831.c5

At a time when most financial news has been depressing, physicians may find a glimmer of hope in the new $787 billion economic stimulus bill passed by Congress and signed by President Obama on Feb. 17. The American Recovery and Reinvestment Act of 2009 is notable for physicians and scientific researchers because, among other provisions, it provides an additional $10 billion, a 36 percent increase, for the NIH and $19 billion to fund the adoption of health information technology (HIT) — electronic medical records.

The additional $10 billion for the NIH — provided over a two-year period — is “a big deal,” said AAN Legislative Counsel Mike Amery of the Washington, DC, office. “The NIH provisions are beneficial and strongly supported by the Academy. We sent out an action alert asking Academy members to send messages to their members of Congress supporting the NIH provisions, and many did just that,” said Amery.

In addition to enabling the NIH to offer new research grants, the extra funds will support capital improvements in the agency's intramural and extramural labs, and provide resources for more evidence-based studies that compare therapies; $1.1 billion will be allocated for the Agency of Healthcare Research and Quality and the NIH for comparative effectiveness research.

The economics package also extends health care benefits, including subsidies for and extension of COBRA benefits for laid-off workers; increases funds for federal medical assistance grants by 6.2 percent for all states, and more for states with high unemployment levels; $1 billion for wellness and prevention programs; $1.5 billion for community health centers; and $415 million for the Indian Health Service. It creates an office of national coordination for HIT and establishes a policy and standards committee.



Amery said the provisions relating to health information technology could have a major impact on physicians. Physicians who have adopted HIT systems and whose first payment year is 2011 or 2012 will be eligible for a bonus payment up to $18,000. In 2014, the payment limit for physician who adopt HIT will be $12,000. The maximum amount of HIT bonuses a physician can collect, over a five-year period, is $44,000.

The bill authorizes the Department of Health and Human Service HHS to adopt rules for establishing standards for health information technology.

On the flip side, however, physicians who do not use a certified health information system by 2015 will face fines — including reductions in Medicare fee schedule payments by 1 percent in 2015, by 2 percent in 2016, and 3 percent in 2017 and thereafter. Penalties could be increased beginning in 2019, but exceptions will be made on a case-by-case basis; for example, for physicians who practice in rural areas without Internet access.

Commenting on the HIT provisions, Mark S. Yerby, MD, associate clinical professor of neurology, obstetrics-gynecology, and public health and preventive medicine at Oregon Health and Sciences University, said that while health information technology is a sound idea, the commercial programs currently available are all very expensive, and quite complex to master effectively. He noted that the greatest obstacle to adopting these systems are their incompatibility; they don't all communicate with each other. “The provisions in the bill for HIT will be potentially most burdensome if they are mandated in a manner that forces major financial investment by practitioners, particularly small groups such as neurologists,” he said.

But, he noted, the provisions for comparative effectiveness research will be helpful for clinicians who face a dearth of evidence-based strategies to compare and choose therapies. “The devil, of course, is in the details,” he said. “Will the agencies choose to address illnesses of significant public health interest or fall back on the old investigator directed research which has yielded so little in terms of improvements in patient care?”



AAN Legislative Affairs Committee member Lily Jung, MD, clinical assistant professor in neurology at University of Washington Medical School, and a neurologist at the Swedish Neuroscience Institute, noted that in the midst of layoffs and overall revenue tightening, the volume of patient visits has declined. Increasingly, patients have had to choose between putting food on the table or taking care of their health, she said, adding that the stimulus package may help to reverse this trend.



Dr. Jung was enthusiastic about the increase in funds for the NIH and science programs, but she said the funds for these initiatives pale in comparison to the more critical need: overall health care reform.

©2009 American Academy of Neurology