The "Medicaid Information Technology to Enhance Community Health Act," unveiled recently by Senator John Kerry, would offer financial incentives to some providers not covered by the 2009 HITECH Act, and brings up some ambiguities in federal health IT initiatives.

Called the MITECH Act, Kerry’s bill would expand Meaningful Use financial incentives for safety net clinics that serve predominantly lower-income Americans but don’t qualify for the Medicaid EHR incentive program.

The incentives in the HiTECH Act missed some parts of the nation’s integrated health system, said Xiaoyi Huang, assistant vice president for policy at the National Association of Public Hospitals and Health Systems. Even as more uninsured Americans turned to safety net clinics in the wake of the Great Recession, the requirements for federal incentives for HIT adoption meant a lot of those clinics haven’t been eligible.

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“The incentives right now pay the hospitals and individual physicians, but ignore other clinics. As of right now, physicians in the clinics have to individually qualify for MU incentives,” Huang said. The MITECH lets them apply for MU as a clinic and, Huang said, “better reflects the integrated nature of how providers deliver care.”

The MITECH Act would extend the incentives to some health professionals working at local health departments, which in some places partly function as safety net clinics. Local health departments get on average 13 percent of their budget from Medicaid, said Eli Briggs, director of government relations for the National Association of County and City Health Officials.

“Many local health clinics have a dual role, because they provide clinical services as well as provide surveillance across an entire population,” Briggs said. “Currently the incentives don’t exactly match the way services are provided by many health departments. About 19 percent of city or county health departments across the country have adopted EHR systems, according to Briggs.

City health departments are more likely to be wired for HIT than rural ones, Briggs said. In Santa Barbara county California, the county public health department is the area’s largest medical provider, and it is adopting an EHR system in anticipation of some 27,000 new patients, as the Santa Barbara Independent reported.

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But various providers have been left out of EHR incentives that they feel they should qualify for. Not being able to adopt EHR systems — with or without federal incentives — could hinder the ability of some safety net clinics to keep pace with the rest of the health system, according to a report from George Washington University researchers, published in January.

The various Medicaid- and Medicare-linked incentive programs have often excluded FQHCs, RHCs and free clinics, researchers from GWU’s School of Public Health and Health Services wrote. “For example, the statutory authorization for Medicare EHR incentives specifies they are for ‘covered professional services furnished by an eligible professional,’ and are related to the Medicare physician fee schedule, but these criteria do not apply to clinicians at FQHCs and RHCs, so they are not eligible for the Medicare incentives... Free clinics are excluded because they generally do not collect health insurance payments and therefore cannot receive bonuses that are tied to insurance reimbursements.”