Snowe Puts Emphasis on Privacy

Posted October 22, 2008 at 2:02pm

Sen. Olympia Snowe (R-Maine) has taken a central role in pushing legislation on health information technology, and in particular, privacy for health care records.

Snowe, a moderate lawmaker who was first elected to the Senate in 1994, has spent several years promoting legislation that would encourage the use of a national electronic health record system. She has worked with Sens. Edward Kennedy (D-Mass.), Mike Enzi (R-Wyo.) and Patrick Leahy (D-Vt.), among others, in an ongoing bid to pass the Wired for Health Care Quality Act (S. 1693).

That legislation would offer grants to providers to defray the cost of purchasing health information technology and to enhance the use of that technology. The bill would also provide a more defined role for the federal government in establishing policies that advance health information technology.

However, Snowe has clashed at times with Kennedy and Enzi, the bill’s sponsors, over specifics on privacy protections, and some officials fear that she has taken too inflexible a stance, potentially hindering passage of legislation that has broad support.

Snowe has argued for more stringent protections than the bill currently provides, including stronger notification of breaches and clearer consent forms.

“I was disappointed to see the Wired Act did not include an effective data-breach provision,” Snowe said in a statement. She did not make herself available for direct questioning.

Snowe is seeking requirements that the secretary of Health and Human Services be notified of data breaches and that there be public reporting as well. “We simply must end the current situation in which Americans hear constantly about their critical health data being lost or stolen, often as a result of a wanton lack of concern for proper security,” Snowe added.

However, even health IT advocates have found themselves frustrated by Snowe’s stance on privacy. They say she is searching for perfection, an approach that effectively prevents a deal from being reached in the Senate, one health care advocate said.

Her desire to stiffen the language on breach notification “basically tanked” efforts to pass a bill this year. Her proposal simply could not get the bipartisan support necessary to move a bill through the Senate, the advocate added.

But Snowe maintains that these privacy safeguards are necessary because of the harm that can be done when a patient’s medical information is leaked.

“Breaches of health records can expose an individual’s entire health history, a disclosure that can be irreparable and have a devastating impact for an individual’s employment and health coverage — and can make them vulnerable to other forms of discrimination,” Snowe said in the statement. Concern about such breaches will keep the public from buying into a health IT system and even seeking out necessary care, she added.

Beyond privacy, lawmakers will also have to grapple with how to offer incentives for providers to adopt health IT.

Doctors and hospitals will face high up-front costs to implement health IT, requiring financial incentives to help offset those costs, Snowe said. “I think we must carefully examine the ways we promote technology so that early adopters are not penalized,” she said.

Specifically, Snowe and Sen. Debbie Stabenow (D-Mich.) are eyeing a carrot-and-stick approach that uses Medicare reimbursements as a tool to encourage compliance. Her strategy is similar to what was proposed by Rep. Pete Stark (D-Calif.), chairman of the House Ways and Means Subcommittee on Health.

However, his proposal is controversial. Under Stark’s Health-e Information Technology Act, physicians who use an approved system would be eligible for incentive payments totaling up to approximately $40,000 over five years, while hospitals that do the same would be eligible for incentive payments of up to several million dollars.

These incentives would be phased out over a few years, at which point Medicare payments would actually be reduced for those who are not yet using qualified systems.

While many advocates and Hill aides believe this is a good idea, they add that it is not feasible given the expected shortfalls in the federal budget.

The estimated $4 billion cost over the next five years would be impossible to handle given the need to offset those costs amid the current declining economy, according to one health IT industry lobbyist.

But Snowe is also looking beyond Medicare payments, proposing grants and tax relief to help ease adoption of health IT systems. These additional incentives “can play a critical role,” she said.

Beyond the current health IT legislative fight, Snowe argues that Congress needs to take a more active role in the development and application of new technology.

“Congress has two major roles in seeing technology improve health care,” she said. “First, we must fund the discovery and innovation so critical to the prevention, early diagnosis and treatment of disease. Second, we must work to improve access to the high quality care that technology makes possible.”

Snowe said she believes that health care should be paid for based on effectiveness rather than the amount of treatment provided. The clearest way to ensure that payments are based on effectiveness is to compare different treatments.

She said she also touts public-private partnerships to facilitate the translation of technological discoveries.

Congress can further that goal by reauthorizing the Small Business Innovation Research program next year, Snowe said.