Josh Israel stories from The Center for Public Integrity

‘Outsider’ candidate Santorum collected millions in corporate PAC money

2012-01-31T21:00:58-05:00

Rick Santorum the presidential candidate casts himself as a Washington outsider, “one of the most successful government reformers in our history,” according to his campaign bio, “taking on Washington's powerful special interests from the moment he arrived in our nation’s capital.”

But Rick Santorum the House and Senate member received more than $11 million in contributions from corporate and other special interest political action committees (PACs) over his career, according to a Center for Public Integrity investigation.

Among the largest donors are giants from the telecommunications, tobacco, and banking industries, the analysis found. The Center examined contributions to the Pennsylvanian’s congressional, senatorial and 2012 presidential campaigns — as well as his “America’s Foundation” and “Fight PAC” leadership PACs, entities set up by Santorum to aid others in their political campaigns.

Corporate PACs connected to telecommunications firms that became today’s AT&T Inc. poured more than $98,000 into Santorum’s campaign coffers, making the behemoth his top career patron.

Those donations may have been rewarded with support for the industry; in 1996 Santorum was one of 91 Senators to approve the heavily lobbied rewrite of telecommunications law that deregulated the industry.

Government watchdog group Common Cause decried the industry for “buying” the legislation.

Verizon Communications Inc. (and companies now part of the Verizon empire, including GTE, Bell Atlantic Corp., NYNEX and Verizon Wireless, a joint venture with British wireless giant Vodafone Group PLC), also made the top-ten (No. 6), with more than $75,000 in corporate PAC contributions.

Santorum’s second-highest total came from the Altria Group, including predecessor companies like the Philip Morris Companies and U.S. Tobacco. The makers of Marlboro cigarettes and Skoal tobacco have spent more than $96,000 in PAC funds to advance Santorum’s political career.

Santorum, a member of the Senate Committee on Agriculture, Nutrition and Forestry, opposed increased restrictions on the tobacco industry — joining with 39 other Republicans and two tobacco-state-Democrats to kill the 1998 Universal Tobacco Settlement Act.

The bill aimed to “prevent the use of tobacco products by minors” and to “redress the adverse health effects of tobacco use.” It also would have incorporated a settlement requiring the industry to pay billions of dollars to state governments. After Congress failed to pass it, a narrower settlement was reached between the tobacco companies and state attorneys general.

In addition, documents made public as a result of the tobacco settlement with the states indicate that representatives from Philip Morris communicated with then-Rep. Santorum in 1994 during the debate on the Clinton health care reform proposals.

A March 20, 1994, interoffice memo notes that several company employees attending public meetings with Santorum reported “very positive” conversations aimed at ensuring his opposition to an increase in the federal excise tax on cigarettes.

Santorum’s Nos. 3, 4, 5, 7 and 8 backers were all financial services companies. Bank of America Corp. and companies it has acquired gave more than $92,000; PNC Financial Services Group Inc., a Pittsburgh-based bank, gave more than $87,000; JPMorgan Chase & Co. gave at least $76,000; Wells Fargo & Co. gave more than $73,000; and Bank of New York Mellon Corp. gave more than $69,000.

Santorum served on the Senate’s Committee on Banking, Housing and Urban Affairs and was one of 54 senators to back the Financial Services Modernization Act of 1999 (commonly known as Gramm-Leach-Bliley), a bank deregulation law signed by President Clinton.

That law eliminated several restrictions on the size and scope of banks, precipitating the mergers that allowed these and other financial services giants to merge and grow. The law has been blamed for setting the stage for the financial collapse of 2008 and resulting recession. Despite the banks’ largesse, Santorum has been a vocal opponent of the Troubled Asset Relief Program bank bailout, often using it as a club against other Republican candidates.

Rounding out the top 10 were GlaxoSmithKline PLC (more than $68,000), a pharmaceutical company, and energy powerhouse Exelon Corp. (more than $67,000).

Corporate PACs are funded by employees who may give up to $5,000 per calendar year. The PAC itself may give $5,000 per election to candidates. These PACs are usually controlled by the corporation’s chief lobbyist.

It should be no surprise that Santorum’s donors are among the biggest corporate interests in the country.

The anti-tax lobbying group Club for Growth rates Santorum’s record on economic issues in the U.S. Senate as “above average,” while the U.S. Chamber of Commerce gave him a 100 percent rating for 2005.

And if elected, it is likely Santorum will continue his support for business.

On his website he promises to cut the corporate tax rate in half “to make our businesses competitive around the world,” eliminate the corporate income tax for manufacturers and sharply reduce taxes on repatriated foreign income. The Center recently reported on how the issue of repatriation is currently a cause célèbre for many large corporations.

As Bloomberg reported recently, since his 2006 Senate re-election defeat, Santorum has received hundreds of thousands of dollars in directors’ fees and stock options from Universal Health Services Inc. Though it did not rank among his top patrons, Santorum received at least $11,500 from that company’s PAC.

Santorum later received a consulting contract with Consol Energy Inc., reportedly worth more than $140,000. The Pennsylvania-based company donated almost $20,000 to Santorum while he was in office. The Center previously reported on Consol’s long-wall mining operations in southwestern Pennsylvania.

Santorum's campaign didn't respond to a request for comment on this story.

Here is a list of Santorum’s top 10 political action committee donors:

AT&T – at least $98,603
Altria – at least $96,500
Bank of America – at least $92,250
PNC – at least $87,805
JPMorgan Chase – at least $76,000
Verizon – at least $75,165
Wells Fargo – at least $73,050
Bank of New York Mellon – at least $69,374
GlaxoSmithKline – at least $68,305
Exelon – at least $67,589

Source: Center for Public Integrity analysis of contributions from political action committees to Rick Santorum’s congressional, senatorial, and presidential campaign committees and leadership PACs: “America’s Foundation” and “Fight PAC.” Data was obtained from subscription-only CQ-MoneyLine, and covered Santorum’s first campaign, in 1989-1990. The data was retrieved Jan. 4, 2012.

Correction, Jan. 18, 11:56am: Due to an editor's error, this story incorrectly said the Santorum campaign had responded to a request for comment. It did not.

Romney PAC gave trash-talking rival Santorum $10K donation in 2006

2012-01-09T13:42:27-05:00

Rick Santorum says Mitt Romney is a “bland, boring, career politician who will lose to Barack Obama” — talk about an ingrate.

Santorum’s criticism came despite his acceptance of a $10,000 contribution in 2006 from a political action committee controlled by Romney.

Romney’s “Commonwealth PAC” sent then-Sen. Santorum the donation in an attempt to gain support among leading conservatives ahead of Romney's 2008 presidential campaign. At the time, Santorum was locked in a tough re-election battle in Pennsylvania.

Santorum finished a mere eight votes behind the GOP frontrunner in the Iowa Republican presidential caucuses Tuesday and is hoping to keep up his unexpected momentum. Santorum made the comment in a recent fundraising solicitation.

Santorum threw his support behind Romney in 2008 — an endorsement he has since tried to walk back, defending it as a move to stop the nomination of Sen. John McCain of Arizona, the eventual GOP nominee.

In a dizzying twist, McCain joined Romney Wednesday to announce his support for the former Massachusetts governor. McCain’s appearance was notable, given how acrimonious things were between the two men during the 2008 campaign.

And speaking of McCain, "Winning our Future," a so-called “super PAC” supporting the candidacy of former House Speaker Newt Gingrich, has gone negative — sort of. Despite Gingrich’s past exhortation to his supporters that they stay positive, the group featured “A Tale of Two Mitts,” a McCain ad from 2008 mocking Romney for his flip-flopping on abortion and gun rights.

Winning Our Future, not to be confused with the pro-Romney “Restore Our Future,” has not released a list of donors, nor will it be required to until the end of the month. Super PACs can raise unlimited amounts from corporations, individuals and labor unions and use the funds to elect or defeat candidates.

The contribution may have gotten Santorum to take Romney’s side, albeit temporarily, but it didn’t help much in the election. Santorum was thumped by now U.S. Sen. Bob Casey, his Democratic opponent, by 17 points.

John Dunbar contributed to this report.

Presidential candidates outspending 'Super PACs'

2012-01-06T17:41:07-05:00

The “super PACs” backing various presidential contenders spent at least $12.9 million last year to help their favorite White House hopefuls — that’s a lot, but it represents only a fraction of the amount spent by the candidates themselves.

Through the end of last September, the campaigns of Democratic President Barack Obama and Republicans Michele Bachmann, Newt Gingrich, Jon Huntsman, Fred Karger, Ron Paul, Rick Perry, Buddy Roemer, Mitt Romney, Rick Santorum and Herman Cain combined amounted to $74 million.

That’s according to a Center for Public Integrity analysis of campaign finance data from the Federal Election Commission and the Center for Responsive Politics.

While these totals do not include any expenses from the fourth quarter of 2011 — those need not be reported until January 31 — they far exceed the amounts spent by their super PAC supporters through December 2011.

In nearly all cases, the respective candidates’ campaign spending far outpaced the technically-unaffiliated super PACs. (Super PACs can accept unlimited donations from corporations, labor unions and individuals and spend the funds to help or hurt candidates.)

While super PACs backing Romney led the way with more than $4.5 million in independent expenditures, his campaign committee spent more than $17.5 million. Obama, who saw super PACs spend $306,229 in support of his re-election, spent over $27 million in campaign funds. And although a pro-Huntsman group spent more than $1.8 million to help the former Utah governor, this amounted to less than half of what his campaign spent: about $4.1 million.

Only Rick Perry’s campaign spending so far this year were smaller than those of his supporters’ super PACs. Perry, who did not announce his candidacy until August, still managed to spend about $2 million through the third quarter of 2011. It is likely that when his fourth quarter totals are released, they will exceed the more than $3.7 million super PACs spent on his behalf.

Individuals can give a maximum of $2,500 to each candidate per election.

John Dunbar contributed to this report.

Tea Party ‘super PAC’ going after Sen. Orrin Hatch

Utah,United States — 2013-04-29T14:42:11-04:00

An outside spending group affiliated with the conservative Tea Party movement is targeting long-time Utah Republican Sen. Orrin Hatch in 2012 for not being conservative enough.

FreedomWorks for America is a so-called “super PAC,” meaning it can accept unlimited donations from corporations, individuals and labor unions and spend the funds on advertising and other expenditures aimed at electing or defeating a candidate.

On Tuesday, the group reported to the Federal Election Commission that it spent more than $43,000 on expenditures to oppose Hatch, including payments to a Utah communications firm for research, a D.C.-based polling firm, an Oregon-based yard sign manufacturer and a North Carolina online services company.

The group is affiliated with the conservative FreedomWorks 501(c4) nonprofit group, which also spends money on campaign advertising, but is not required to reveal its donors.

Ryan Hecker, a spokesman for the super PAC, told iWatch News the group opposes what it calls Hatch’s support for increased federal government spending and support of the Department of Education and the Department of Housing and Urban Development.

The organization is required to reveal its donors, but is too new to file a report. The super PAC launched in September and promised a grass roots approach to organizing rather than a massive ad buy.

Former House Majority Leader Dick Armey (R-Texas), chairman of FreedomWorks, said “Our Super PAC is not about buying television ads, it’s about engaging the American public, and getting them outside talking to their neighbors and putting up yard signs.”

Armey said the group wants to “build a grassroots army of active volunteers” to knock off Democrats but also to “hold Republicans accountable to the principles upon which they got elected.” The group’s YouTube page does include three videos, but none mention Hatch.

Hecker says his group is working to provide Utah-based activists with the resources they need to defeat Hatch, including polling, focus groups, online phone-banking, direct mail, door-hangers, and palm cards.

That total also included $7,762 in payments from the super PAC to the FreedomWorks Inc., the nonprofit for “staff and overhead.” The groups share office space and some staff.

Hecker declined to identify the group’s donors.

The affiliated FreedomWorks Inc. was formed in 2004 when Empower America merged with Citizens for a Sound Economy. Billionaire David Koch, an energy executive, political activist, and 1980 Libertarian Party vice presidential nominee, was chairman of Citizens for a Sound Economy and a co-founder.

A spokesman for Sen. Hatch did not respond to a request for comment by publish time.

Pro-Romney super PAC using media firms tied to Swift Boat, Willie Horton ads

2011-12-13T17:54:52-05:00

A recent ad attacking Republican presidential frontrunner Newt Gingrich by a pro-Mitt Romney “super PAC” was produced and distributed by some of the same consultants who were behind two of the most controversial advertisements in American presidential campaign history.

The “Restore Our Future, Inc.” super PAC paid $44,666 to McCarthy Hennings Media, Inc., a Washington, D.C., media consulting firm whose president, Larry McCarthy, made the infamous “Willie Horton” ad in 1988. The ad helped sink the candidacy of Democratic nominee Michael Dukakis. McCarthy is also a co-founder of the super PAC.

In addition, a payment of $782,052 went to Mentzer Media Services, Inc. for the media buy, according to Federal Election Commission records.

The Towson, Md.-based firm was paid more than $18 million for its work in the “Swift Boat Veterans for Truth” campaign and was the largest beneficiary of the group’s spending, according to the Center for Responsive Politics. The ads accused 2004 Democratic nominee John Kerry of distorting his war record.

The anti-Newt Gingrich “Smiling” ad, as reported last week by iWatch News, first appeared on YouTube and was removed when reporters asked another of the group’s co-founders about the spot. Now, it is back online and, according to a spokeswoman for Restore Our Future, is currently on the air in Iowa.

The group has also been airing a second ad, entitled “Now You See the Problem,” which supports Romney and criticizes President Barack Obama. According to FEC records, the group spent $826,719 on the two ads.

The group said last week it will spend $3.1 million on television and radio advertising in Iowa. Spokeswoman Brittany Gross told iWatch News that that total includes the two spots running currently and future ads.

Mentzer’s clients have included House Majority Leader Eric Cantor (R-Va.), the Republican Governors Association and conservative groups such as the Club for Growth and the Progress for America Voter Fund. A Mentzer spokesman said the firm does not comment on its clients or its work.

Some top donors to the Swiftboat committee have donated to Restore Our Future, including former U.S. Ambassador Sam Fox and Texas homebuilder Bob Perry, a prolific contributor to Republican groups.

Super PACs were formed following the Supreme Court’s Citizens United decision, which allowed corporations and labor unions to spend money supporting or opposing candidates.

Experts say these new super PACs — which are prohibited from coordinating with candidates — may fill the role of attack dog while insulating the candidates themselves.

Bill Allison of the non-profit Sunlight Foundation, which advocates for transparency in government, sees this happening in the 2012 races.

“Some [super PACs] are almost shadow campaigns, or the flip side of the campaign,” he said. “The advantage is they can run the negative advertising without it coming back to bite the candidate — having this other vehicle to do that kind of dirty work allows candidates to be positive in their ads.”

Veteran campaign finance reform advocate Meredith McGehee, policy director at the Campaign Legal Center, suspects these ads are just the beginning.

“We’re still in the off year,” she notes, and “as people really focus in, I still would expect super PACs to be much more visible on television, much more on the negative road.”

She says because they are a relatively new entity, many independent expenditure-only committees have had to spend this off year getting organized.

“That’s slowed them down but,” she said. “It won’t last for much longer.”

The Willie Horton ad said then-Massachusetts Gov. Dukakis had allowed weekend prison furloughs for felons, including convicted murderer Willie Horton, an African American. Horton kidnapped and assaulted a young couple while on a furlough, and raped the woman. Critics accused the creators of the ad of being fear mongering racists. The ad was paid for by the Natonal Security PAC, an outside expenditure group.

A call to McCarthy Hennings Media was not returned.

And now, left-wing Mitt Romney, out of context and in French

2011-12-12T18:33:31-05:00

A new political ad, entitled “French Mitt Romney,” shows a video of the presidential candidate speaking in French, poorly, promoting the 2002 Salt Lake City Winter Olympics.

But the subtitles are a bit off – actually they don’t mention the Olympics at all. They consist of old quotes from the former Massachusetts governor, promoting such un-Republican positions as support for abortion rights, gun control and fighting global warming.

The ad is a swipe at Romney’s anti-President Obama spot, which used a quote from the president in 2008, saying: "If we keep talking about the economy, we're going to lose.” Obama was actually quoting an aide to his opponent, Republican Sen. John McCain of Arizona.

Many of the quotes are lifted from Romney’s 1994 and 2002 Massachusetts statewide campaigns – where his audience was a bit more Democratic – and are in contrast with the more conservative image he has put forth for 2012.

The ad was created by a new “Super PAC,” a political committee that can accept corporate and labor money and spend it on the political races. AmericanLP filed its statement of organization with the Federal Election Commission Thursday.

Its treasurer and founder, TJ Walker, is described on the group’s website as a “longtime Democratic and corporate media trainer and consultant.” In an interview with iWatch News, Walker said the group’s goal “is to be more hard hitting and more humorous than what a typical candidate or party can do.”

When asked about the group’s biggest funders, Walker said, “Me, unfortunately.”

He said the group is “absolutely unaffiliated with any candidate” and has bought time on CNBC, MSNBC, and Bloomberg. Walker declined to say the size of the buy.

Walker said the ad is payback for 2004 attacks on former Democratic presidential nominee, Massachusetts Sen. John Kerry’s fluency in that language. But why attack Romney when former Speaker of the House Newt Gingrich has surged ahead in the polls?

Romney is the strongest general election candidate in Walker’s view, and he hopes to convince Republican primary voters to nominate a weaker candidate. Walker hopes Republicans “throw [Romney] overboard and pick Newt Gingrich,” who he believes is unelectable.

The Romney campaign did not immediately respond to a request for comment.

Pro-Perry ‘super PAC’ biggest presidential spender, Romney group looms

2011-12-07T10:37:02-05:00

With a $550,692 ad buy, a group that is backing Texas Gov. Rick Perry for the Republican nomination for president has become the top spender among so-called presidential “super PACs” – for now, anyway.

“Make Us Great Again, Inc.” has spent more than $1.47 million since its formation on July 28 but has yet to reveal its donors.

A super PAC can accept unlimited corporate and union contributions and spend the money on advertising and other expenditures to support or oppose a candidate. Prior to the Supreme Court’s Citizens United decision in January 2010, such contributions were illegal.

Super PACs are prohibited from coordinating with the candidate, an issue that has raised questions for Make Us Great Again. The group has been linked to Perry’s former chief of staff, Mike Toomey.

Our Destiny PAC, a super PAC supporting former Utah Gov. Jon Huntsman Jr., has spent a little more than $1.45 million to date. A pro-Romney group, Restore Our Future, Inc., has raised more than $12 million and is only now preparing to make its first expenditures.

Make Us Great Again lists a post office box in Washington, D.C. as its address. Its treasurer is Paul Kilgore, of Athens, Ga. Kilgore, a former aide to late Georgia Republican Sen. Paul Coverdell, runs a political financial consulting company called PDS Compliance in Athens.

He is also treasurer for ChristinePAC (a super PAC connected to failed former Delaware Republican Senate candidate Christine O’Donnell), the leadership PAC for New Jersey Republican Rep. Scott Garrett, and the conservative Madison Project Inc., among others.

“Elites,” the new advertisement from Make Us Great, is a 30-second spot showing images of President Obama and House Minority Leader Nancy Pelosi with a voiceover: “Washington elites are wrecking America, destroying our way of life.” The ad is running in Iowa and South Carolina.

As the background music brightens, the voice adds “Rick Perry isn’t from Washington. His spending reforms balance the budget. His energy plan frees America from foreign oil. And his tax reforms flatten and simplify. That’s how we’ll put America back to work.”

This is the third television spot the group has produced since early November. Thus far the committee has spent at least $1,472,681, according to the Center for Responsive Politics — tops among all presidential super PACs.

Perry, while serving as governor from 2001 through 2010, raised $102.8 million, according to good-government group Texans for Public Justice. Among his top backers was Houston homebuilder Bob Perry who gave the governor more than $2.5 million.

Perry is currently running fourth in the Jan. 3 Iowa cacuses, according to a new Washington Post-ABC News poll, trailing frontrunner Newt Gingrich, Romney and Ron Paul.

A spokesman for Make Us Great Again did not return calls from iWatch News seeking information on the group's donors.

Federal Election Commission rules require super PACs to report their donors in regular filings. Perry supporters have also organized a nonprofit, Citizens for a Greater America, to back the candidate, as reported by iWatch News, but that organization is not required to reveal its donors.

This story has been updated.

John Dunbar contributed to this report.

As states build exchanges, questions linger about interoperability

2011-11-03T09:27:18-04:00

As 56 U.S. states, territories and the District of Columbia inch toward a 2015 deadline for creating “exchanges” allowing health providers to share electronic medical records, those on the front lines of the effort are expressing concern about whether these systems will be able to talk to their counterparts in other regions.

A 2009 mandate from the feds actually requires states to build systems that can communicate with each other, but officials involved say questions about interoperability have largely been put on the back burner while each state or territory struggles to establish an exchange appropriate for its residents.

President Barack Obama’s 2009 economic stimulus bill provided $548 million in grants to help states establish or expand exchanges. Rather than mandate a one-size-fits-all approach, states were permitted to design their own structure, subject to the approval of the Office of the National Coordinator (ONC) for Health Information Technology.

As a result, a wide array of models are being used. Some states are building centralized state databases to house all patients’ health information. Some are building transmission systems to allow providers to securely send records to each other. And some are relying on multiple regional exchanges, tied together but operating individually.

The overall idea is to increase efficiency. By allowing providers to share information, doctors will easily be able to learn about their patients’ medical histories and exchange information.

While an iWatch News canvass of state and territorial exchanges showed virtually unanimous optimism that systems will be operating by the late 2014 or early 2015 deadlines required by grant contracts, this will only guarantee that records can be exchanged within the same state or territory.

But there’s far less optimism regarding information exchanges across jurisdictional borders. A patient living in Arlington, Va., for example, is likely to see providers in his or her Northern Virginia neighborhood, in the District of Columbia, and in the Washington suburbs in Maryland. If the exchanges for these three jurisdictions cannot communicate, the patient’s information will not catch up. The benefits of health information exchanges would therefore be lost for patients who live near state borders, who seek medical treatment while traveling, or who change their residency.

In tourism-driven Nevada, state health information technology coordinator Lynn O’Mara is concerned about ensuring interoperability. “A lot of patients who hold residency outside of the state try to access care when they are visiting,” she said.

Some state leaders have begun informally strategizing with neighboring state exchanges. New York officials, for instance, said they are talking with their New Jersey counterparts to facilitate interstate health information exchange. Ohio, which has contracted with the technology firm Medicity to build its platform, is talking to other states using the same software.

Though Puerto Rico has no bordering neighbors, it too is focusing on interoperability. Dr. José Piovanetti, the territory’s health information technology coordinator, said his agency has “already begun high-level talks with states that have a large population of Puerto Ricans” and states that send large numbers of travelers to the island, such as Florida, New York, Connecticut, Massachusetts and Texas.

Some states are further along in the setup process than others, adding another complication to collaboration. Delaware, for example, was the first state to begin establishing a model for its exchange. Dr. Jan Lee, executive director of the state’s effort, said they are starting to look across their borders. “If Maryland or Pennsylvania were ready, we would love to exchange data with them. So far, they are not.”

Other states have not yet begun to focus on interstate communications. Edward Dolly, deputy commissioner for West Virginia’s state health information technology office, said his state will “focus on interoperability with surrounding states in year two” of their efforts.

Julia Adler-Milstein, assistant professor at the University of Michigan and leading expert on health information exchanges, said a national exchange is technically possible. But federal law did not define what an ideal system should look like, in part to provide state coordinators with more flexibility so they could more easily claim more progress, she said.

A National Exchange

Dori Henry, director of communications for Maryland’s Department of Health and Mental Hygiene, noted that under rules established by the federal grant program, each state that participates must be able to connect to a Nationwide Health Information Network under development. “The national network is not yet in place and will likely not be available for states to connect to for at least another year,” she said. The requirement was spelled out in the office of the national coordinator’s 2009 funding opportunity announcement.

But the national network is already in its embryonic stage. The South Carolina Health Information Exchange, for example, is one of 20 participants already securely exchanging information in the nationwide network — ONC says it expects about 35 entities to be part of the national exchange by the end of 2011.

But much work remains to get all 56 states and territories linked into this system. Parmeeth Atwal, an ONC spokesman, describes the effort as “a challenge of a breadth and scale never attempted in any other nation.” He says the agency has collaborated with the health care community to create “a common standard enabling the electronic movement of health information,” by establishing a “simple, secure, scalable, standards-based transportation mechanism” that gives participants the ability to send encrypted health information directly to known, trusted recipients over the Web even if they are not part of the same exchange. More than 40 states are using this as part of the implementation approach, according to Atwal.

But not all observers are as confident as ONC.

Adler-Milstein of the University of Michigan says the mechanism Atwal references will be akin to secure email and will fall short of the seamless interoperability of a true national exchange, which would give the most benefit. This is “a good interim step,” she says, but there is a risk that providers get used to that and then not move beyond it.

Pam Matthews, senior director of regional affairs at the Healthcare Information and Management Systems Society (HIMSS), a nonprofit that promotes understanding and use of health information technology, said addressing this component of exchange will include significant issues — not just in technology, but other aspects of privacy, security and policy.

Stimulus funds will build state health exchanges but might not sustain them

2011-11-08T15:33:40-05:00

Federal stimulus funds are paying to build or expand systems enabling health care providers within each state to share patient information, but state officials are concerned about how to keep paying for the programs once the federal money runs out, an iWatch News survey reveals.

And with states adopting a wide variety of different software for electronic health record exchange, officials are also worrying about how to get those different systems to talk to each other across state lines (see sidebar).

The creation of these exchanges within all U.S. states and territories is part of a much larger push for use of electronic records in health care. Most of the attention has been focused on $27 billion worth of Medicare and Medicaid incentive payments that are going out to doctors, hospitals and clinics for switching their patients’ information from print to digital; providers must also demonstrate they have followed government guidelines in using the technology in a “meaningful” way. But a less-noticed provision of the same 2009 stimulus legislation made $548 million worth of grants available to the states to set up information exchanges that would allow health care providers to send, receive and share patient information within a state.

The federal government started distributing the State Health Information Exchange Cooperative Agreement Program grant money in March 2010 after approving each state’s proposal. But the funding will be handed out in increments until late 2014 or early 2015.

The purpose of the exchanges

Ideally, the exchanges would allow providers within a given state to track their patients’ medications, allergies, medical history, tests administered at other facilities, and surgeries by other physicians — therefore improving health care overall and lowering the risk of error or duplication.

Rather than establish one national exchange or mandate for any one particular approach, the federal Office of the National Coordinator (ONC) for Health Information Technology asked each state and territory to propose a plan for a state exchange that would meet its needs.

Pam Matthews, senior director of regional affairs at the Healthcare Information and Management Systems Society (HIMSS), a nonprofit that promotes understanding and use of health information technology, said there wasn’t a “best model” or approach that could apply to all state exchanges. “Each state is unique and their [exchanges] will mirror their unique state characteristics, needs and requirements,” she said.

First steps

While most states are establishing these exchanges from scratch, about half a dozen had exchanges in place before the stimulus announcement. Those were built with a mixture of state and private funding.

An iWatch News survey of state health information exchanges suggests that states in the nascent stages are using the vast majority of available federal dollars to cover the considerable costs of envisioning, designing and implementing the program. Huge percentages of the funds are going to software vendors to pay for the technology infrastructure, meaning states will have to find other revenue sources for long-term sustainability. Fifty-one U.S. states and territories responded to questions about the progress their agencies or nonprofit entities have made toward meeting the benchmarks in their proposals to ONC; representatives from the District of Columbia, Mississippi, Northern Mariana Islands, New Jersey and Oklahoma did not respond to repeated requests for comment.

The answers revealed that some are further along than others, but all who did respond expect to have a working exchange by the end of 2014 or beginning of 2015.

Ohio, which did not have an exchange in place before the program began, has used the funding to hire Medicity, a Utah-based technology firm, to build its platform. “Our biggest need has been financial, and ONC is supplying that for us,” said Dan Paoletti, CEO of the Ohio Health Information Partnership, the non-profit designated by the state to coordinate the effort. “Were it not for invaluable funding from the federal government, we could not have accomplished what we’re doing today,” he said. Ohio received a grant of nearly $15 million from ONC for its exchange.

Maine began creating its system in 2006 and used a combination of foundation and state funding. “All of this was made possible by voluntary funding stream,” said Jim Leonard, director of the office of the state coordinator for health information technology in Maine. The federal funds allowed the state to get more health care providers signed on and allowed them to upgrade to more sustainable technology. “If the stimulus funds hadn’t come along, it’s unlikely that the project would have continued,” Leonard added.

Finding more money

While state agencies were virtually unanimous in expressing appreciation for the federal support from ONC — not only in cash but also in training and guidance — several coordinators of health information exchanges are worried about where the cash will come from to keep the exchanges running over the long haul. Though the states were required to submit long-term sustainability plans to ONC in their proposals, many questions remain unanswered.

Julia Adler-Milstein, assistant professor at the school of information and the school of public health at the University of Michigan, has conducted formal evaluations of 27 different states for ONC as a subcontractor for a University of Chicago-based research group. “The message coming out of every state is that they haven’t figured out the sustainability piece,” she said.

“They have to charge somebody something,” said John Derr, a consultant at Golden Living LLC and member of the Standards Committee for health information technology, which makes recommendations to ONC. “The problem is that I don’t know whether all the states are working to see what the best model is … I think probably they need more guidance on which models work and which models don’t.”

States expect little additional federal support in this era of tightened Washington spending. Sheldon Wolf, health information technology director for North Dakota, said the federal dollars would be enough to “get the process started, but not for continuing operations.” Wolf declined to estimate how much those continuing operations would cost annually, noting that it would all depend on the number of participants.

Rather than rely on cash-strapped state governments to make up the gap, many exchanges are looking to subscription and per-transaction fees from providers as future revenue sources. Oregon officials, for example, say they hope to sustain a state health information exchange service through provider subscriptions, though they haven’t set any pricing models yet. Ohio’s Paoletti said his state plans to charge “reasonable fees for services that will bring value to participants.”

Nebraska’s Lt. Gov. Rick Sheehy, who heads the Cornhusker State’s health information technology efforts, said a subscription to the state’s exchange would not cost physicians “much more than what they would pay per year to have cable in.”

But conveying the value of these systems to stakeholders is another issue. Jan Lee, executive director of Delaware Health Information Network, said, “We’re struggling to get insurers to pony up and be a financially contributing member [of the exchange].” With Delaware one of the states furthest along in establishing its exchange — 90 percent of residents have their clinical data in the system — Lee wonders how a successful business model will be possible elsewhere. Under the non-profit Delaware group’s business plan, insurers would be asked to pay about 75 cents per member, per month. But, Lee says, health plans have been reluctant to sign on because there has not been much industry-wide data documenting savings. “Everyone believes intuitively this ought to save money,” she notes, but that is not enough in an industry “driven by actuarial information.”

Financial participation has been an easier sell to Delaware hospitals and labs, however, who pay 25 cents per transaction, as long as they have eliminated paper reports. Those who have, she says, enjoy a “clear, unmistakable cost savings,” compared to the $1.25 to $1.80 per transaction average cost for paper delivery.

Adler-Milstein said communicating the value of exchanges to providers was one of the biggest obstacles for states. Health care providers will need to understand how they can benefit from the exchanges before they will be willing to pay for them, she said.

“We’re not really clear who health information exchanges are creating value for,” she said. “Lots think it’s the patients, but at the end of the day I think we haven’t convinced anyone that health information exchanges are creating value for anyone.”

That skepticism was evident in an interview with Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, a group that has been critical of the president’s health care reform and of federal health information technology spending. The group encourages its members to eschew participation in health information exchanges — with or without user fees. She said she thinks the exchanges open too many opportunities for privacy and security violations. “If physicians care about [patient] confidentiality then they shouldn’t participate,” she said.

Even the American College of Physicians, a trade group that supports the exchanges, refused to endorse a pay-for-use model, remaining neutral on the question of who should pay. Spokesman David Kinsman said his group “has no policy other than that it supports development of exchanges,” though he acknowledged that without ongoing government funding, sustainability will be a challenge.

Gene Ransom III, CEO of MedChi, the Maryland State Medical Society, said long-term payment plans have to be addressed because ultimately they could lead to privacy issues. He fears that if states do not find a way to sustain the exchanges once the federal dollars run out, they might have an incentive to make use of the data in a way that could compromise patient privacy — like sell it, he said.

MedChi specifically pushed for legislation, enacted earlier this year, to prevent this possible scenario in the state.

“If you’re a state with a tight budget and this hasn’t been a priority, and you have a health information exchange that was set up using federal dollars,” he said, “doesn’t that put pressure for them to deal with the most valuable thing they have, like data?”

Parmeeth Atwal, ONC spokesman, said the agency is helping states with the issues of interoperability and has developed standards for the exchange of health information. He says the agency is working to help states “fill gaps in a strategic way” to “encourage and sustain health information sharing.”

Atwal describes the federal grants as a “one-time investment” aimed at providing “a critical impetus” to facilitate state health information exchange.

Adler-Milstein said the government was on the right track in pushing doctors and hospitals to begin using electronic health records. She thinks, however, that getting providers invested in the program is ultimately what will make it successful. “We can build a great health information exchange,” she said, “but if providers aren’t using it then it’s going to be useless.”

But Ransom from MedChi would like to see more federal investment in health information exchange systems. “It’s the classic situation that government should be involved with,” he said. “When the federal government sets up a system where there is strong encouragement for this, then they should take the responsibility to do it.”

Adler-Milstein predicted that by the end of the program there would be significantly more exchanges but many would likely be within pockets of the country — such as local health information exchanges.

“Some states are going to be a success and some are going to be failures,” she said. “For the states that don’t succeed it will be seen as a nice experiment and what they build will not continue to operate.”

Super Congress hauls in super donations as special interests try to influence budget cuts

2011-10-26T10:34:23-04:00

Members of the congressional Super Committee have received more than $300,000 from 93 special interests in just six weeks since they were appointed, according to an analysis of FEC data by iWatch News. More than a third of the money came from health-related interests as the committee of 12 debates serious cuts to Medicare and Medicaid.

The donations from political action committees slightly favored the Republicans on the panel (officially titled the Joint Select Committee on Deficit Reduction; unofficially dubbed the Super Congress). Republicans got 84 donations for $181,000; Democrats received 63 donations totaling $121,000.

The analysis covered Aug. 11, the day the committee was formally announced, through Sept. 30, the end of the third quarter reporting period. And those dollar amounts will likely increase when the Senate contributions, which are not filed electronically, are submitted to the FEC.

Formed as part of a compromise in late July between Republicans and Democrats in Congress, the committee faces a serious uphill task: they must come up with $1.5 trillion or more in budget savings, enough to match increases in the government's ability to borrow enough money to pay its bills through the beginning of 2013. It requires a bipartisan majority of at least seven of the committee's 12 members to recommend legislation to be presented to the whole Congress for an up-or-down vote by Dec. 23.

The select panel has until the day before Thanksgiving to finish its work.

As the committee seeks trillion-dollar spending cuts, interest groups have weighed in heavily with letters, lobbying efforts and, of course, campaign cash.

Of the 93 special interest groups who donated via their PACs to the members during this period, seven gave at least $10,000. They were:

FedEx, the shipping giant — $10,500
Pfizer, the pharmaceutical manufacturer — $10,000
The National Beer Wholesalers Association, a trade association for beer companies — $10,000
The American Dental Association, the trade association for dentists around the nation — $10,000
Walt Disney Productions, the entertainment conglomerate — $10,000
Chevron, the oil giant — $10,000
The Associated General Contractors of America, the trade association of the construction industry — $10,000
Fresenius Medical, a major dialysis provider— $10,000

A mix of health and pharmaceutical companies made up at least $111,500 of the donations, by far the biggest business sector. One focus of the Super Committee is to find ways to save money on health care, which many have speculated means potential cuts into Medicare and Medicaid.

Fresenius Medical provides a good example for how companies may be attempting to influence the Super Committee members. Fresenius is one of the largest dialysis providers in the world, operating over 1,800 clinics in the U.S. alone.

With the number of Medicare patients receiving dialysis (and, accordingly, the Medicare expenses for renal disease treatment) going up in recent years, the reimbursement rules and procedures for these treatments have already been a hot topic among those seeking to improve Medicare. A CMS rulemaking process is already under way for a quality incentive program. Should the Super Committee propose changes to Medicare, Fresenius and other dialysis companies could see a major impact to their bottom lines.

In the six weeks since the committee was announced, Fresenius made three donations to committee members Reps. Chris Van Hollen ($1,000) and Jim Clyburn ($5,000), along with Sen. Max Baucus ($4,000). The last time the company had donated to either Van Hollen or Clyburn was in June of 2008; in January of this year the company gave $5,000 to Baucus’ Glacier PAC.

Fresenius is a member of the Kidney Care Partners trade group and donated $5,000 in June to the group. Abbott Laboratories, another member in the kidney association, made six donations for $7,500 to Super Committee members during this time period.

Shortly after the Super Committee was launched, Kidney Care Partners wrote a letter to the committee, urging Congress to allow kidney patients enrolled in the new health exchanges to have their dialysis paid for by private, primary insurance for up to 30 months. Currently, when a patient is diagnosed with kidney failure, they are automatically enrolled in Medicare, regardless of age. “It is incumbent upon all Americans to work towards a more cost efficient and intelligent health care system,” reads the letter. “Public health care dollars are precious and should be wisely and efficiently spent.”

Kidney Care Partners spokesman John Jonas said Medicare cuts affect the dialysis industry more than other areas because upwards of 80 percent of its business is from Medicare. "We feel Medicare cuts very strongly. We're particularly vulnerable, and there's no alternative."

Jane Kramer, vice president for public affairs and communications at Fresenius, told iWatch News in a statement that the company “frequently engages members of Congress and Administration representatives to ensure that they understand the unique nature of dialysis and the various issues that impact the treatment of individuals with end stage renal disease.”

“By engaging with policy makers directly, we are able to provide them with a perspective to which they may not otherwise have access. In turn, this helps better inform their decisions on critical issues such as access to quality care for all Americans, including those with chronic kidney disease,” the statement said.

Not all members of the committee are raising big bucks around their committee membership. Sen. John Kerry, a Massachusetts Democrat, promised last month that he would raise no money until the committee’s work is completed in late November. Meanwhile, Sen. Jon Kyl announced in February that he will not seek re-election when his term ends in 2012.

Total received from PACs to Super Committee members, 8/11-9/30:

Rep. Dave Camp, R-Mich. — $90,000
Rep. Xavier Becerra, D-Calif. — $38, 500
Rep. Jim Clyburn, D-S.C. — $36,500
Rep. Fred Upton, R-Mich. — $36,150
Sen. Max Baucus, D-Mont. — $29,000*
Rep. Jeb Hensarling, R-Texas — $22,500
Sen. Pat Toomey, R-Pa. — $18,000*
Rep. Chris Van Hollen, D-Md. — $17,500
Sen. Rob Portman, R-Ohio — $10,000*
Sen. John Kyl, R-Ariz. — $5,000*
Sen. Patty Murray, D-Wash. — $0*
Sen. John Kerry, D-Mass. — $0**

*Senate numbers still coming in

**Promised not to raise money while on Committee; returned two donations made during that time

Health information technology: Incentives may not always serve intended purpose

2011-10-13T10:37:20-04:00

About half of the first batch of federal dollars meant to encourage doctors and hospitals to switch to electronic records went to providers who were converts to the technology long before the stimulus program was announced, an iWatch News analysis suggests.

The analysis could raise questions about whether the government will be able to meet its goal of widespread adoption of health information technology. While these early numbers are hardly conclusive, they suggest that a large swath of payments intended to be an incentive for new adoption of electronic health records are merely rewarding health providers for minor adjustments to systems they have had in place for years.

Proponents of the program are undeterred, arguing that it is on track and has established important industry standards. Opponents question the efficiency of the payments, though, and some have even called for Congressional repeal. All of this comes at a time when the president is pushing a new stimulus bill, the “Super Committee” is attempting to rein in federal spending, and the United Kingdom is abandoning much of its own health information technology project.

The first installment

About 320 doctors and hospitals were included in the first batch to receive incentive payments through Medicare — payments that totaled $75 million. Those payments began during the two weeks following the launch of the program April 18 by the Centers for Medicare & Medicaid Services (CMS). The details of the initial batch were released by the agency at the end of May.

The payments represent the first installment on a $27 billion incentive program designed to compensate health care providers for both adopting often-expensive computerized medical recordkeeping systems and proving that they have used them to improve patient care.

To be eligible for the first round of payments, health care providers must attest to having adopted 23 out of 25 “meaningful use” benchmarks, a checklist the government developed to ensure providers are recording and keeping track of their patient’s health information in a standardized way. Among the examples: recording smoking status, maintaining a list of allergies to medications, documenting demographics and providing patients with an electronic copy of their health information. Providers must also have technology that is able to collect, analyze and report the measures, engage patients and transfer information to other providers. For many, this will mean installing a complex and expensive software update.

The incentive program, to be administered through both Medicare and Medicaid, is part of President Barack Obama’s 2009 economic stimulus, the $787 billion American Recovery and Reinvestment Act. The incentive provision is known as the Health Information Technology for Economic and Clinical Health (HITECH) Act. The idea behind it is that creation of a computerized health record for every American will cut health care costs in the long run. A CMS spokesman said the agency has distributed nearly $400 million in both Medicare and Medicaid payments, and that by the end of the summer, that figure might well exceed half a billion dollars. The government hasn’t required medical providers to adopt electronic health records — but will penalize them if they do not, by deducting 1 percent to 5 percent of their Medicare payments from 2015 to 2019.

iWatch News attempted through phone and email to interview all providers who had received the money; 62, or about a third, of the 188 distinct practices (some with multiple doctors who received money) and hospital chains on the list chose to respond. Health providers were asked for the brand of the technology they installed, when they installed it, whether they would recommend it to other providers and whether they have had any problems with it.

Of those who responded to the questions, almost half of the providers had installed the technology in the years before the stimulus program was announced — some dating as far back as the 1990s.

Early Adopters

Those who already had electronic recordkeeping systems were still able to take advantage of the HITECH Act incentives by upgrading their existing software and demonstrating to the government that the improved system was meeting those “meaningful use” standards in improving patient care.

Dr. George Miller, a surgeon who practices in Grenada, Miss., said his decision to adopt electronic health records had nothing to do with the stimulus — in fact, he has been using the technology for a decade. His company made upgrades to the software after the HITECH Act. “When we achieved ‘meaningful use,’ I figured I might as well get reimbursed,” he said.

The same was true for Dr. Jeffrey Willig, an ophthalmologist in Syosset, N.Y., who said doctors should take advantage of the government’s generosity. “If you’re going to do it anyway, then why not do it and have someone else pay for it?” he said.

Dr. Rafi Kevorkian, an internist in St. Louis, Mo., said he began using electronic health records in November 2009 and didn’t find out about the incentive program until he got going. Though electronic health record-keeping systems have saved him a lot of time and keep him on top of health maintenance, he said he thought filling out the “meaningful use” forms was “a pain” that he would be dealing with for the next four years through the different stages of the program. He also noted it was costly to have IT personnel help.

Dr. Luis Calo, who has a family practice in Harlingen, Texas, told a different sort of story. When he started his new practice in late 2009, Calo said, the HITECH money spurred him to invest in electronic recordkeeping software. He selected his system specifically to make sure it would allow “meaningful use” and used the $18,000 incentive payment toward the startup costs. Moving forward, he hopes to use the next rounds of Medicare payments toward monthly fees, upgrade costs, and, if necessary, hardware expansion.

Providers will have other chances to meet the “meaningful use” requirements and receive incentive payments. Medicare payments that have gone out this year are only part of the first phase of three for “meaningful use,” the second of which may be delayed a year (until 2014). The three stages will give providers three separate opportunities to cash in on the stimulus to help defray the hefty costs associated with going digital. Systems can cost as much as $45,000 per physician, with annual operating, licensing and maintenance costs ranging from $3,000 to $9,000, according to a 2008 report from the Congressional Budget Office. Participants have through the end of 2013 to participate in the first stage, but the maximum they can recoup will decrease each year. Until the end of 2014, an eligible professional who qualifies for the different benchmarks can receive a maximum of $44,000 from the government; hospitals can received a maximum of $2 million.

Should Early Adopters Qualify?

So, if one aim of the payments is to encourage adoption of health information technology adoption, why give them to providers who already have electronic recordkeeping systems in place?

Some lawmakers believe it’s important not to penalize early adopters of the technology. Rep. Anna Eshoo, D-Calif., introduced a bill in 2007 that provided much of the basis for what eventually went into the HITECH legislation. According to her office, “The idea was to eventually get everyone using health information technology, but to use it together.”

“Promoting the adoption of health information technology will yield great improvements to patient safety, efficiency and costs from preventable medical errors,” Eshoo said.

“We’re making progress and I look forward to seeing total adoption across our country.”

Dr. Lyle Berkowitz, an internist and medical informatics expert, said he is unconcerned about whether the payments go to new or old adopters.

“In fact many of the ultimate ones who get the ‘full’ ‘meaningful use’ dollars will be getting rewarded for ‘doing the right thing’ before there were even rewards to do so … which is actually not a bad message to send,” he said.

“Even for those of us using [electronic medical records] for many years, ‘meaningful use’ is not a slam dunk — it requires a lot of work and updating of technology and workflows … but it’s easier for us than starting from zero.”

Brian Bruen, lead research scientist and lecturer at George Washington University’s Department of Health Policy, said he thought it was too early to draw conclusions about the findings in the analysis. Many providers, he said, are taking a “wait-and-see approach.”

But he said there are benefits to paying early adopters because the legislation requires providers to improve their level of capability to allow for more streamlined, integrated, cost-effective care. “We’re not paying for nothing,” he said.

Others disagreed. A spokesman for Sen. Tom Coburn, R-Okla., an obstetrician, said that “if providers have been paid for systems they already had in place, that seems to be an inexcusable waste of taxpayer dollars. It makes no sense for HHS to pay physicians for systems they already have.” Coburn criticized the HITECH Act in his July “Back in Black” deficit reduction plan and proposed ending federal subsidies for health information technology. Coburn noted that according to the nonpartisan Congressional Budget Office, “the use of health information technology was already projected to be widespread by the end of the decade — even without the adoption of the HITECH Act.”

Pete Sepp, a spokesman for the National Taxpayers Union, said he thought the stimulus program was designed more for speed than effectiveness — “get the money out the door and hope that the eligibility requirements would work out.”

“Elected officials who want to appear to be ‘doing something’ about a problem create a program that involves a good PR boost without necessarily providing an equally valuable result for the investment of tax dollars,” he said.

One fear, expressed by Brock Slabach of the National Rural Health Association, is that smaller health providers will struggle to meet the complicated and expensive demands of the HITECH Act.

“If the public policy agenda was to move providers that couldn’t afford or didn’t have the resources … I think the jury is still out,” he said. “ I think we’ll find the ones that were far along will be further along and the ones who didn’t are going to go nowhere.”

And the rules, some doctors say, are confusing. One recipient, Dr. Mark Viner — a psychiatrist who practices in Sparks, Nev. — said he opted to return the initial payment after realizing that his private practice may not have treated enough Medicare patients to qualify.

Despite the issues raised by both the iWatch News findings and various critics, the CMS spokesman made clear the agency is pleased with the program thus far. “The most important point,” he said, “is that these incentive payments represent an investment in improving health care through the widely acknowledged benefits of electronic health records.”

Improving Patient Care

Of the health care providers who have switched to electronic health records, the majority of those who spoke to iWatch News were positive about the systems. Several said the technology has tremendously helped their practice by speeding up transactions, decreasing the amount of time patients spend in the waiting room, and helping patient progress.

Andy Wilson, a spokesman for Texas Health Resources, said electronic health records have reduced the provider’s medical errors and reduced costs as well.

And Dr. Michael Mignoli, an internist in Lone Tree, Colo., raved about his system. “It provides me the opportunity to deliver high quality care,” he said. Mignoli first started using electronic recordkeeping in 1995 and said he could not “give a higher recommendation” to his current software.

But for many, the transition hasn’t been easy.

Dr. Mark Johnson, a podiatrist who practices in West Plains, Mo., and who participated in the Medicare incentive program, said getting used to the software was time-consuming.

“I've got a lot of colleagues who aren't doing ‘meaningful use’ at all,” he said. “For solo doctors, it's a burden. It puts a lot of stress on staff, assistants and the receptionist.”

This view was echoed by Dr. Alfredo Gonzalez, a Glenview, Ill.-based cardiologist. He called the government regulations “absurd in many ways” because they force him to spend “more time writing data that is irrelevant to patient care and less time taking care of patients.”

Dr. David Kibbe, a physician and senior adviser for the American Academy of Family Physicians said that even the best-managed, most-organized practices are going to face some loss of productivity. Health care providers who are starting from scratch know that beginning to adopt computerized health records already carries its own set of problems, with or without the “meaningful use” criteria.

Podiatrists have their foot in the door

2011-10-12T13:10:09-04:00

A disproportionate number of those receiving the first batch of incentive payments to install electronic health records are podiatrists, an iWatch News analysis suggests.

Of the 188 different practices and chains that received the first batch of payments in May, 23 were podiatry practices, or about 12 percent — even though podiatrists make up only about 1.5 percent of Medicare physicians and practitioners.

Those numbers are no accident, according to Dr. James Christina, himself a doctor of podiatric medicine and director of scientific affairs for the American Podiatric Medical Association (APMA), the national trade association for podiatrists.

The APMA, Christina noted, has made a “very directed effort” to educate its members about both health information technology generally and how to meet requirements that providers demonstrate “meaningful use” of health IT in order to receive the incentive payments. “These efforts have included webinars, online resources on our website, live lecture presentations at regional and national meetings, and regular e-news type communications.”

Indeed, were it not for the APMA’s efforts, podiatrists might not even have been made eligible under the program. Several types of medical providers — including many behavioral health providers, rural health centers and home-care practitioners — were left out of the HITECH incentive payments. Thanks in part to lobbying by APMA — the group reported spending at least $45,000 to ensure “HIT Incentives for non-MD/DO physicians” and other issues in the first quarter of 2009 — podiatrists were ultimately included among the ranks of the eligible. The APMA has been “very active commenting on proposed rules from CMS, participating in the development and implementation of quality measures, and making sure through the legislative process that podiatrists were included as eligible providers,” Christina said.

In May, the Centers for Medicare & Medicaid Services (CMS) released a list of the first 320 recipients of “meaningful use” incentive payments under Medicare. At least 25 of those were doctors of podiatric medicine, nearly 8 percent. Several payments went to multiple doctors in the same practices and multiple hospitals in the same system. Of the 188 different practices and hospital chains receiving payments, 23 were podiatry practices, or about 12 percent. Joe Kuchler, a CMS spokesman, told iWatch News that podiatrists make up about 15,500 of the roughly 1,022,900 Medicare participating and non-participating physicians and practitioners — only about 1.5 percent.

iWatch News attempted to reach all 25 providers to ask them about the software they are using. Seven practices responded. Of those seven, three said they are using TRAKnet PM – DPM Edition by BioMedix (electronic medical recordkeeping software specifically tailored to podiatrists) and two were using software by MedLink.

Five of the seven indicated that they had installed the system in the time since enactment of the HITECH act in 2009. While part of the legislation’s intent is to provide incentives to encourage new providers to adopt electronic medical recordkeeping, it also allows for incentive payments to those who already had systems in place prior to the bill’s passage. About half of the 55 non-podiatrist providers and facilities who responded to iWatch News inquiries were receiving repayment for software they had already installed prior to the HITECH Act.

For Dr. Laura Pickard, a podiatrist who practices in Chicago, the Medicare incentive payments were “definitely the factor” that caused her to switch from print to electronic health records. She installed the technology in mid-November 2010, she said, and collected patient data for 90 days, as is required in HITECH, to show she was practicing “meaningful use” and should qualify for the stimulus payments.

She was among those who received the first round of payments, and says that although she is still adapting to the technology — causing her patients to have longer waits — her practice has benefitted overall. “I am more acutely aware of all of their health issues [and] medications,” she told iWatch News. “For diabetics I can keep a closer eye on them to help better manage their diabetes and potential complications.”

Some in the medical community are not thrilled to see the podiatrists reaping benefits of HITECH that are not available to some other practitioners. Behavioral health providers, a group not eligible to receive incentive payments for health information technology, say the inclusion of podiatrists reveals the program’s unfairness of excluding all “non-acute providers.” The behavioral health designation includes clinical psychologists, clinical social workers, psychiatric hospitals, substance abuse treatment centers, mental health treatment centers.

During the fast-moving stimulus negotiations, behavioral health advocates focused their lobbying efforts on privacy issues, only to discover once the stimulus was released they were excluded from being eligible to receive incentive payments.

“Had we been given the opportunity, I think we could have said that our patients are as acute and bring as severe medical problems as podiatry patients,” said Al Guida, a lobbyist for behavioral health interests. “A psychiatric crisis is life threatening. I’m not aware of any podiatric conditions that will lead to your demise.”

Dr. David Kibbe, a physician and senior adviser for the American Academy of Family Physicians, said the organization of workflows by podiatrists has always impressed him. “It may well be that the single greatest reason for such high adoption is that podiatrists have their act together,” he said.

He also noted that podiatrists might have an easier time meeting “meaningful use” objectives because they have limitations on the types of procedures they do. For example, “meaningful use” has different lists doctors must fill out for vaccinations, prenatal care and blood pressure.

“The reason could be that podiatrists don’t do a lot of things that are in the objectives, and therefore they can exempt themselves from having to fulfill some of the requirements,” he said.

Not so, says Christina of the APMA. “All eligible providers have the option to report zeros or exclusions where applicable,” he noted. “I do not think being able to report zeros on some quality measures makes qualifying for ‘meaningful use’ any easier.”

As FEMA funds run out, senators from states with most disasters oppose funding bill

Texas,United States — 2011-09-29T12:11:22-04:00

Eleven Republican U.S. senators who represent the states with the most FEMA-declared disasters since the start of 2009 voted against a bill designed to keep the agency’s disaster relief fund from running out of cash, an iWatch News analysis reveals.

The top two states, Texas and Oklahoma, combined for more than a quarter of the Federal Emergency Management Agency’s declared disasters since Jan. 1, 2009. Still, the four Republicans from those states most frequently aided by FEMA opposed legislation to increase the fund without offsets. One of them, Sen. Tom Coburn of Oklahoma, said to do so would be “unconscionable.”

Along with Texas (75 disasters) and Oklahoma (45), seven other states also had 10 or more disasters declared since the start of 2009, shortly before President Obama took office. All seven Democratic senators from these states joined with a unanimous Democratic conference and eight Republicans to advance legislation to add $5.1 billion to the fund. In the wake of costly relief efforts following Hurricane Irene, Tropical Storm Lee, and wildfires across Texas, FEMA’s relief fund teetered on the verge of running out of money this week, with few dollars remaining to get the agency through the end of the fiscal year.

But most Senate Republicans and the GOP-controlled House of Representatives balked at the price tag of the Democratic bill, arguing that any infusion of extra FEMA funds should be paid for by cuts elsewhere. On Sept. 13, the Senate advanced a stand-alone bill by a mostly party-line 61 to 38 vote.

Sen. Lamar Alexander, a Tennessee Republican and a member of his party’s leadership, told CNN that the Democrats “manufactured a crisis… Everyone knows we’ll pay every penny of disaster aid that the President declares and FEMA certifies.” Senate Democrats objected to Republican proposals to offset increased FEMA costs through spending cuts, including cuts to clean energy programs for the automobile industry. Sen. Debbie Stabenow of Michigan decried the GOP approach for its “job-killing offset to what is an important disaster assistance bill.”

On Monday, the Senate passed a package to avert a government shutdown after stripping some of the FEMA provisions from the bill when the agency affirmed that it now appears to have sufficient funds to close out the year.

“It’s political maneuvering,” says Ben Smilowitz, executive director for the Disaster Accountability Project, a nonprofit group dedicated to holding disaster relief agencies accountable. He said elected officials often pressure FEMA and the White House for quick aid when disaster strikes in their districts. As such, he told iWatch News, “It’s a little ironic that members of Congress are trying to reign in FEMA when often they’re the ones pressuring the agency to reverse decisions to release funds for their state.”

Such pressures were evident in May when FEMA denied assistance to Texas to help battle wildfires. Both Sens. John Cornyn and Kay Bailey Hutchison made public statements decrying the decision not to provide aid to the state, while Gov. Rick Perry hinted that he believed the Obama administration was pursuing a vendetta against Texas.

“We’ve yet to enter the hottest months of the year and already wildfires have wreaked havoc in Texas—yet our state has not received sufficient federal disaster aid,” Cornyn said at the time.

FEMA numbers show that Texas, with 75 declared disasters since the start of 2009, has had by far the largest number of FEMA declarations of any state. And when they had the opportunity to vote more funds for FEMA last week, both senators voted against the Democrats’ bill; on Monday, they did not record votes on a newer resolution. Neither responded to a request for comment.

Perry, now a front-runner for the Republican presidential nomination, has steered clear of the FEMA fight in Congress and his campaign spokesman did not respond to requests to comment on this story. Despite his campaign rhetoric against the federal government, Perry has come to rely on it for aid, with federal money making up more than half of the state’s funding for emergencies. And after recently making massive cuts to state funding for volunteer fire departments across the state, Perry requested more FEMA funds to help battle wildfires that have devastated the state.

After being denied the FEMA funds he sought, Perry said in May, “It is not only the obligation of the federal government, but its responsibility under law to help its citizens in times of emergency.”

Although Texas leads the way in declared disasters during this time period, it lags in total dollars received from FEMA with about $20 million.

The state that received the most money was Kentucky, with about $293 million, most of which came after a severe ice storm in February 2009. Kentucky is represented in the Senate by Minority Leader Mitch McConnell and freshman Rand Paul, Republicans who voted against both the Sept. 13 bill and the two bills this week. Both Senators indicated they would be in favor of additional funding for FEMA only if it came with the offsets like those in the House version of the bill, although McConnell said on the Senate floor “In my view, this entire fire-drill was completely unnecessary.”

After the 2009 ice storm, McConnell was grateful for the speed of the federal government’s disaster aid. “Doing that has triggered the release of urgently needed federal authority and funds that will give the people of my state the help they desperately need,” he said then. “I want to thank the governor for his quick and decisive action, as well as President Obama for his speedy response. It is making a real difference in the lives of Kentuckians as we speak.”

Arkansas (about $254 million) and Missouri (about $222 million) round out the top three states that have received the most FEMA money since January 2009. (Data on the FEMA site is current through June 15 of this year.)

Arkansas Republican Sen. John Boozman voted against both bills, despite his praise for FEMA in June. “From the feedback I received while visiting Arkansans during that state work period, FEMA has been very responsive and helpful to Arkansans in need,” he wrote after a series of vicious storms tore through his state.

Spokesman Patrick Creamer told iWatch News, “Senator Boozman strongly supports supplemental disaster relief funding, especially in light of the recent disasters in Arkansas. The problem is not if we should have a bill, but how to pay for the additional money needed.” Without changes, he said, “Senator Boozman could not, in good conscience, vote for a bill that would put this country in further financial straits.”

Sen. Roy Blunt of Missouri broke with Republicans on the Sept. 13 vote, but opposed advancing the larger Democratic spending proposal on Monday. He issued a release afterwards acknowledging that in the wake of the catastrophic Joplin tornado in May, his state needed all the FEMA aid it could get, but called for the Senate to simply pass the House version, including the offsets, in order to speed the process along.

Arkansas Democrat Mark Pryor and Missouri Democrat Claire McCaskill both backed the Democratic proposals.

What would the result of offsets be? Smilowitz, of the Disaster Accountability Project, warns that requiring offsets for FEMA funding may actually hinder future disaster response. “If we had to offset the response to 9/11 or Katrina or Hurricane Ike, what the result would [have been] with lives lost and suffering on the ground?” he asked.

Republicans counter that asking for offsets is nothing new. Becky Bernhardt, deputy press secretary for Oklahoma Sen. Coburn, pointed to the Oklahoma City bombing case. “The 1995 emergency disaster assistance bill that included relief funds for victims of the Oklahoma City bombing that was entirely offset," she told iWatch News.

That bill paired $7.2 billion in emergency funding with $16.3 billion in budget rescissions, cuts to unspent federal appropriations. As to Coburn’s opposition to the bill which helps disaster-ridden states like Oklahoma with recovery efforts, Bernhardt said “Working to find ways to pay for bills and not just add them to our already enormous pile of debt, has always been and continues to be, a priority” for Coburn and he opposes increasing FEMA spending without offsets. Coburn, like the senators from Texas, did not vote on Monday’s bill.

Though it had origins in the early 1800s, FEMA as it exists today was created by an executive order from President Carter in 1979 at the request of the National Governors Association, which wanted to centralize the federal agencies that dealt with emergencies. Although started with an eye towards dealing with fallout from a war, FEMA began focusing more on disaster relief and recovery in the early 1990s.

Sen. Mike Johanns, R-Neb., another elected official from a state with double digit FEMA declarations, agreed that offsets are needed. Press secretary Paul Donahue told iWatch News that the senator voted against the Democrats bill last week because “That bill was never really intended to pass. It was pretty irresponsible.” Johanns voted against Monday’s bill.

Like Johanns, Sen. John McCain, R-Ariz., voted against both bills. His spokesman, Brian Rogers, said the former presidential candidate “believes we should offset spending wherever we can rather than adding to the deficit and debt.”

The offices of Sens. Paul, McConnell, Alexander, James Inhofe of Oklahoma, Jon Kyl of Arizona, Bob Corker of Tennessee and Pat Roberts of Kansas did not return requests for comment.