Stimulus bill left many providers out, but costs of including them may doom the measure

Democratic Sen. Sheldon Whitehouse from Rhode Island introduced the Behavioral Health Information Technology Act earlier this month to include mental health providers in a stimulus program that rewards health care providers who install electronic health records. Credit: Joe Giblin/The Associated Press

A first-term senator is seeking to include mental health providers in a stimulus program that rewards clinics, hospitals and doctors who invest in computerized health records — a move advocates say is a reflection of the field’s decades-long struggle to be viewed as equal to other health providers.

Sen. Sheldon Whitehouse (D-R.I.) introduced the Behavioral Health Information Technology Act, the likely vehicle for this effort, earlier this month. The bill has been referred to the Senate Committee on Finance. And while some supporters say the measure could save money over the long term, others believe the bill’s likely near-term funding requirements will doom it in the current atmosphere of spending restraint.

If enacted, the measure would extend the Health Information Technology for Economic and Clinical Health (HITECH) Act portion of the 2009 stimulus legislation. HITECH offers funding to advance the use of electronic health records, and sets aside $27 billion in Medicare and Medicaid payments for health providers that show they have installed the technology and used it to improve patient care.

Physicians, chiropractors, dentists, optometrists, podiatrists, psychiatrists, and most hospitals qualify for the payments. But “behavioral” health providers — clinical psychologists, clinical social workers, psychiatric hospitals, substance abuse treatment centers, mental health treatment centers, and others whose patients experience a multitude of psychological and biochemical disorders — are ineligible to receive reimbursement funds, in part because lawmakers were trying to limit HITECH’s costs. Other groups not eligible for HITECH include home-care practitioners, long-term care providers, post-acute providers, Federally Qualified Health Centers, Rural Health Centers, rehabilitation hospitals, and cancer centers.

Only 8 percent of all behavioral health providers have fully implemented electronic records, according to the 2009 Behavioral Health/Human Services Information Systems Survey, conducted by the nonprofit Centerstone Research Institute.

Implementing the technology without a boost from Congress will be difficult for mental health and addiction treatment providers because most already are under-funded and under-reimbursed for their services, said Julio Abreu, senior director of government affairs at Mental Health America, a nonprofit that has lobbied in support of the legislation.

Whitehouse introduced a similar bill last year, after his fellow Rhode Island Democrat, then-Rep. Patrick Kennedy, authored the House version. Neither bill made it past committee or even received a committee vote as Congress wrestled with financial-sector reform, an arms treaty, the repeal of “Don’t Ask, Don’t Tell,” and health care reform.

Broader goals

“The mental health community has a larger agenda — we want to be integrated into the rest of health care,” said Al Guida, a lobbyist for the behavioral health community.

That vision seemed to gain traction in late 2008, with passage of the Kennedy-sponsored Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. The legislation prohibited most insurance plans from charging higher premiums for mental illness treatments than for treatments involving physical ailments; the bill also generally prohibited insurers from setting restrictions on mental health care. The legislation was enacted as part of the bank bailout bill and signaled a broader change in policy requiring that mental health care be seen as equal to other branches of medicine.

But when the stimulus passed in 2009, mental health providers were once again left out. “The HITECH Act was originally going to be a $50 billion proposal, but it was scaled back … In that process, primary care providers and services were prioritized,” said Chuck Ingoglia, vice president of public policy for the National Council for Community Behavioral Health Care, who has lobbied in support of Whitehouse’s legislation.

If the new bill cannot pass on its own, lawmakers will likely try to lump it in with another Medicare provision at the end of the year, said Guida, the behavioral health lobbyist.

Advocates of the measure say patients’ computerized records should include behavioral health, mental health, and substance abuse treatment information because one medication or disorder can often impact another.

“If the rest of the health care system is wired for [health information technology] and the mental health field isn’t getting reimbursement for that technology, it will be impossible for us to communicate with the rest of the health care system,” Guida said. “We need the resources to report the same clinical data that our medical and surgical colleagues will be able to do going forward.”

Debating the costs

Allowing all health providers access to that information would improve care and reduce costs, claim backers of the bill. As a result, they say, the legislation would produce long-term savings for the government. The Congressional Budget Office, however, has yet to score the bill, and the Obama administration has not thus far issued a statement of administration policy in regard to the legislation.

But promises of long-term savings may not offer much reassurance to a Congress already hesitant to spend money — particularly when it comes to health care. Brian Darling, director of government studies at the conservative-leaning Heritage Foundation, said he thinks the bill’s chances of passage are low, especially if Congress does not find other programs from which to cut. The government would have to add money to HITECH, he said, and while health IT has a lot of support in Congress, expanding the stimulus does not.

“In the short run it’s going to cost a lot of money — and we don’t have a lot of money right now. It’s easy to promise that it will pay off in the long run, but we don’t have that luxury right now,” Darling said.


Even some supporters worry that in the current congressional climate, any bill that increases short-term outlays will be met with vigorous opposition.

Darrell West, vice president and director of governance studies and founding director of the Center for Technology Innovation at the Brookings Institution, said he believes it is vital to include mental health providers in health IT.

“The problem comes in the price tag,” he said. “Everyone is looking to cut dollars and produce greater savings. Part of the goal of health IT is to save money down the road and make the system more efficient and effective. It’s a hard sell for any investment that costs money up front and produces benefits down the road.”

Nevertheless, Whitehouse’s argument will focus on future savings. The Rhode Island lawmaker “believes there are tremendous savings to be realized through delivery system reform, which will reduce medical errors, simplify administrative processes, and rebalance physician reimbursements to pay for the best quality care instead of the number of procedures,” said his press secretary, Seth Larson, in an email.