Economic recovery package already affecting health care

Those who attended the 2009 Edward C. Mazique Symposium heard Saturday three unique perspectives on stimulus funds during, “Improving the Nation’s Health: Has the Economic Recovery Legislation Brought the States Any Closer to Comprehensive Reform?”

Alvin D. Jackson, M.D., director of the Ohio Department of Health, Columbus, Ohio, spoke about how American Recovery and Reinvestment Act of 2009 (ARRA) influences access to care. He shared ways in which his state has benefited from ARRA and addressed the larger context of the current health care reform efforts in the United States.

Funds received from ARRA are helping the state bounce back from one of the worst economic situations at the state level since the Great Depression. ARRA has enabled Ohio to enhance access to health care for its residents in a number of ways. ARRA funds are being used to invest in community health centers, increase the number of vaccines administered at the local level, and increase the number of early childhood visits and screenings through the “Help Me Grow” program, among other enhancements.

“Those area dollars are extremely important to our economic recovery,” Dr. Jackson said. “Because of the funds that ARRA has invested in community health centers alone, 77,000 more Ohioans have access to health care.”

If history is any indication, public health has an important role to play in the shaping of health care’s future, he said.

“We really have to focus on the prevention and the role that public health can play,” Dr. Jackson said. “In the last 100 years, we’ve added 30 years of expectancy — 25 from public health initiatives and five from clinical medicine.”

Dr. Jackson also noted that health care reform starts with each of us in the form of prevention.

“Lifestyle choices are the greatest contributor to poor health,” he said. “The best way to protect ourselves against dangers like diabetes and heart disease is by not smoking, eating right and exercising regularly. Prevention is key to good health and preventive measures result in significant health care savings.

“Social determinants of health care — such as the environment we are born into, where we grow up and how we are educated — are important factors, but they’re not the only factors. The lifestyle choices we make for ourselves are just as critical.”

Kalahn Taylor-Clark, Ph.D., MPH, research director at The Brookings Institution, Washington, D.C., spoke about how ARRA will influence groups affected by health care disparities in the United States.

She covered how expansions in Medicaid and the Consolidated Omnibus Budget Reconciliation Act (COBRA) will affect impoverished populations, and how the change to electronic health records (EHR) will affect under-resourced health care providers and patients.

“What we know right now is only 9 percent of acute care hospitals and 13 percent of physicians have electronic health records,” Dr. Taylor-Clark said. “Ultimately what this means is that installing electronic health records may be cost-prohibitive for some providers, particularly those who are under-resourced.”

The cost of installing electronic health record systems ranges from $25,000 to $45,000, she said. Another $3,000 to $9,000 is needed to operate and maintain the systems.

“Those providers who may be under-resourced may face a greater burden in not only being able to take up the health records systems, but to use them appropriately,” Dr. Taylor-Clark said.

Both financial incentives and penalties, she said, will be in place to reward or punish providers based on how they use their health records systems.

To be deemed a “meaningful user” of the systems, providers must:

• Have certified electronic health records technology — which may include having systems with fields for race, ethnicity and language, to appropriately stratify performance information to better assess disparities in a population
• The systems must be used for electronic exchange and transfer of information
• Providers must be able to take up all the necessary information

“The idea here is that communication inequalities may affect some providers’ abilities to access, process and utilize the information on the incentive structure outlined in the ARRA,” Dr. Taylor-Clark said. “Thus, some providers may be disadvantaged in terms of how they implement EHRs.”

Providers, she said, must keep up with the flow of information from electronic health records.

“As the information comes out, they need to make themselves as fully aware of what the financial incentives and penalties will be for acquiring electronic health records and what ‘meaningful user’ means,” Dr. Taylor-Clark said. “This is extremely important for physicians, especially physicians of color who are more likely to treat patients of color.”

Sylvia R. Garcia, commissioner for Harris County, Houston, covered how the ARRA influences the delivery of care.

Garcia brought her perspective as a commissioner in the third most populous county in the nation that also manages a hospital district supported by taxes.

“Only through communication and the exchange of ideas can we work to follow the dollars from their origin in an effort to see that they do not get lost in bureaucracy, administrative excess and fraud,” she said.

The commissioner shared three examples of stimulus money being used in her county.

“Two of them, interestingly enough, have been assigned to electronic medical records projects,” she said. “The third is money yet to be distributed to FQHCs (Federally Qualified Health Centers). I hope discussion about how that money might be used will prove fruitful at this symposium.”

Garcia said it’s challenging to quantify how ARRA influences the delivery of care.

“I think the best we can do is try to be involved in the allocation process at the earliest level possible so as to be able to track the funds and ensure that they actually end up being used for their intended purpose,” she said.

The commissioner added she is glad she was able to participate in the symposium.

“I am honored and humbled to have been asked — both as a county commissioner and as the president of NALEO (National Association of Latino Elected and Appointed Officials),” Garcia said.

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