Why Tech Should Care About the Fate of Obamacare

on April 4, 2012

Supreme Court portraitYou probably haven’t heard of Section 10330 of the Patient Protection and Affordable Care Act. It takes up just one of the law’s 2,700 pages, buried deep in a list of miscellaneous provisions.

But Section 10330, one of the many provisions far removed from controversies over individual mandates that could be lost if the Supreme Court rules the entire law unconstitutional, is important to the future of both health care and effective use of information technology by government. The substance of the section is so brief that it is worth reading in its entirety:



(a) IN GENERAL.—The Secretary of Health and Human Services
(in this section referred to as the ‘‘Secretary’’) shall develop a
plan (and detailed budget for the resources needed to implement
such plan) to modernize the computer and data systems of the
Centers for Medicare & Medicaid Services (in this section referred
to as ‘‘CMS’’).
(b) CONSIDERATIONS.—In developing the plan, the Secretary
shall consider how such modernized computer system could—
(1) in accordance with the regulations promulgated under
section 264(c) of the Health Insurance Portability and Accountability Act of 1996,
make available data in a reliable and timely manner to providers of services
and suppliers to support their efforts to better manage and coordinate care
furnished to beneficiaries of CMS programs; and

(2) support consistent evaluations of payment and delivery
system reforms under CMS programs.

The problem is simple. The Centers for Medicare & Medicaid Services, like many government agencies, is sitting on a treasure trove of data. Applying modern data analytics to this “big data” information could yield tremendous benefits to the public, from detecting fraud in medical payments to understanding regional disparities in pricing of services to–most important of all–learning which treatments provide the best outcomes for patients.

CMS, which administers Medicare, Medicaid, and the State Childrens’ Health Insurance Program (sCHIP) would be an analytics paradise if only it could figure out how to use its data. But the system described in the white paper “Modernizing CMS Computer and Data Systems to Support Improvements in Care Delivery,” Medicare payment information is stored in “in at least 25 different databases used for different program purposes.” These systems mostly have no way to communicate with each other. States maintain their Medicate data in 50 separate state databases, generally without even common data definitions.

Similar problems plague information systems throughout the federal government. The big difference is that in health care, Congress has at least tried to do something about it. The Health Improvement Technology for Economic and Clinical Health (HITECH–they obviously come up with the acronyms first) Act, part of the 2009 stimulus bill, created incentives for a switch to electronic medical records and started the process of CMS tech modernization. But the Affordable Care Act takes on the heavy lifting, authorizing a top-to-bottom overhaul of a technology infrastructure that, among other things, still depends on mainframes communicating over IBM’s 1970s-vintage Systems Network Architecture.

It’s tempting to argue that the overdue and uncontroversial IT modernization mandated by Section 10330 would survive even if the Affordable Care Act as a whole is struck down. It’s also almost certainly wrong. In today’s Washington, nothing is uncontroversial and almost nothing gets done. What is more likely instead is that any attempt to sweep up and resurrect the many technical provisions of ACA would instead end up being held hostage to the broader health care, economic, and political agenda of one side or the other.

I have no illusions that I can influence the Supreme Court, especially at this late date. But I would hope that in the general interest of progress, if the justices decide that the individual mandate is unconstitutional they would at least let the rest of the law go forward.