Bill Overview
Title: To amend title XI of the Social Security Act to require CMI testing of incentive payments for behavioral health providers and certain other providers for adoption and use of certified electronic health record technology, and for other purposes.
Description: This bill prohibits behavioral health providers from receiving Centers for Medicare & Medicaid Services Innovation Center incentive payments for testing certified electronic health record technology unless the provider has acquired health information systems that meet specified information technology standards and rules for interoperability and patient access.
Sponsors: Rep. Matsui, Doris O. [D-CA-6]
Target Audience
Population: Individuals using behavioral health services
Estimated Size: 57000000
- Behavioral health providers are the primary group targeted by the bill since they are directly affected by the requirements to receive incentive payments.
- The legislation impacts global health providers and facilities involved in behavioral health services through the adoption and use of certified electronic health record technology.
- The bill indirectly affects patients who use behavioral healthcare services by potentially improving the quality and accessibility of their healthcare through better use of technology.
- Electronic Health Record (EHR) technology vendors might be impacted as behavioral health providers may seek systems meeting specified standards.
Reasoning
- This policy primarily impacts behavioral health providers by incentivizing the use of certified electronic health record (EHR) technology. Providers need to invest in IT infrastructure to meet these standards, potentially improving patient care but adding financial burdens, especially for smaller practices.
- The policy also indirectly impacts patients using these services. Better EHR systems can lead to improved care coordination, easier access to personal health information, and potentially better health outcomes.
- A large population of behavioral health providers and their patients in the US could be affected. However, not everyone will be equally impacted; larger institutions may adapt easily compared to smaller practices with limited resources.
- The budget constraints suggest limited funds will be available for initial implementation costs, which may restrict the levels of outreach and support provided to all affected parties.
Simulated Interviews
Licensed Clinical Social Worker (Rural Kansas)
Age: 45 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I worry about the costs of updating our systems to meet these new standards.
- Interoperability and better patient data access sound great in theory, but we need financial help to make this leap.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 6 |
| Year 20 | 8 | 6 |
Psychiatrist (New York City, NY)
Age: 38 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 6/20
Statement of Opinion:
- Our hospital is already equipped with advanced EHR systems, so this policy will likely have a minor impact on us.
- It's a positive step towards standardized care, but smaller clinics might struggle.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 8 |
| Year 10 | 9 | 8 |
| Year 20 | 9 | 8 |
Patient (Seattle, WA)
Age: 29 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 20.0 years
Commonness: 10/20
Statement of Opinion:
- I'm excited about having better access to my medical records, which can help me manage my health more effectively.
- I'm concerned that my smaller healthcare providers might face challenges upgrading to these new systems.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 9 | 7 |
| Year 20 | 9 | 7 |
Owner of a behavioral health clinic (Suburban Texas)
Age: 53 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- This policy could push us out of business if incentive payments don't cover the cost of upgrades.
- It's hard to see the immediate benefits of these changes.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 8 | 5 |
Health IT Consultant (Chicago, IL)
Age: 60 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 20.0 years
Commonness: 3/20
Statement of Opinion:
- This policy is a potential boon for my business, as providers will seek consultancy for compliance.
- It's a necessary step for improving healthcare quality, but proper support is crucial.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 9 | 8 |
| Year 2 | 9 | 8 |
| Year 3 | 9 | 8 |
| Year 5 | 9 | 8 |
| Year 10 | 9 | 8 |
| Year 20 | 9 | 8 |
Nurse at a mental health facility (Atlanta, GA)
Age: 34 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- We've been preparing for EHR system changes, so the transition might not be too difficult.
- It's a chance to improve patient data management and care coordination.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 7 |
| Year 20 | 9 | 7 |
EHR software developer (Los Angeles, CA)
Age: 40 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 20.0 years
Commonness: 4/20
Statement of Opinion:
- This policy is likely to drive demand for EHR systems that meet specific standards.
- Our focus will be on helping clients adapt to these requirements smoothly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 9 | 8 |
| Year 20 | 9 | 8 |
Psychologist (Boston, MA)
Age: 50 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 6/20
Statement of Opinion:
- Interoperability will enhance our research capabilities by providing more comprehensive data.
- Implementation within our institution is likely manageable, but external partners might face difficulties.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 8 | 7 |
| Year 20 | 8 | 7 |
Licensed Professional Counselor (San Francisco, CA)
Age: 28 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- I'm eager to integrate modern EHR systems in my practice, but the cost is concerning.
- Proper implementation might enhance service delivery to my clients.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 7 |
Retired patient (Miami, FL)
Age: 67 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- Enhancements in technology sound beneficial, but I'm worried about the security of my personal health information.
- I hope my care doesn't get more complicated as systems change.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Cost Estimates
Year 1: $10000000 (Low: $8000000, High: $12000000)
Year 2: $8000000 (Low: $6000000, High: $10000000)
Year 3: $5000000 (Low: $4000000, High: $6000000)
Year 5: $2000000 (Low: $1500000, High: $2500000)
Year 10: $1000000 (Low: $500000, High: $1500000)
Year 100: $1000000 (Low: $500000, High: $1500000)
Key Considerations
- The policy focuses on incentivizing the adoption of certified EHR technology among behavioral health providers.
- Implementation challenges might include supporting providers in transitioning to compliant systems, especially smaller providers with limited resources.
- Long-term success depends on the compliance level of providers and the ability to meet specified standards.
- Potential unintended consequences could involve temporary disruptions in service delivery during the transition phase.