Archive for February, 2009

Federal EHR Incentives – Required Certification

Wednesday, February 25th, 2009

January 5 UPDATE – Definition of “Meaningful Use”

ONCHIT has released “Meaningful Use” regulations that will impact EMR certification and providers’ qualification for ARRA EMR incentives. Learn more here.

July 17 UPDATE – Multiple EHR Certification Groups

The Health IT Policy Committee has suggested that multiple groups engage in the certification of EHR systems. Previously, the Certification Commission for Healthcare Information Technology (CCHIT), a private organization, had a monoploy on EHR system certification. The Health IT Policy Committee also recommended that officials examine gaps between existing CCHIT certification criteria and the emerging definition of “meaningful use”.

July 16 UPDATE – Definition of “Meaningful Use”

The Health IT Policy Committee approved a work group’s revised recommendations for defining “meaningful use” of electronic health records. Current elements of the definition of “meaningful use” include:

    Allow patients to access their health records in a timely manner;

    Develop capabilities to exchange health information where possible;

    Implement at least one clinical decision support rule for a specialty or clinical priority;

    Provide patients with electronic copies of discharge instructions and procedures;

    Submit insurance claims electronically; and

    Verify insurance eligibility electronically when possible.

Read more here.

July 13 UPDATE – Definition of “Meaningful Use”

The comments period for the first release of a working definition of “meaningful use” ended on June 26. Following are links to comments submitted by a number of organizations.

    CCHIT comments
    The Markle Foundation comments
    The American Hospital Association (AHA) letter
    College of Health Information Management Executives letter
    The American Medical Association (AMA) letter and comments
    Healthcare Information Mangement Systems Society (HIMSS) comments
    eHealth Initiative comments

June 23 UPDATE – Definition of “Meaningful Use” – Standards and Certification Criteria

The HIT Standards Committee is meeting today to discuss the application of standards and certification criteria to the definition of “meaningful use” of health IT (EHR). No additional information is available at this time.

June 16 UPDATE – Definition of “Meaningful Use”

The HIT Policy Committee today offered some criteria that it feels should be part of the definition of “meaningful use”. You can view the Meaningful Use Workgroup’s June 16, 2009 update here.

April 16 UPDATE – Definition of “Meaningful Use”

A workgroup of the HIT Policy Committee has until June 16 to deliver its recommendations for a working definition of “meaningful use” of electronic health records. If the Committee approves the definition, it will be forwarded to ONCHIT for approval and adoption.

April 8 UPDATE – HIT Standards Committee and HIT Policy Committee

The HIT Standards Committee has received over 1,000 nominations, but as of today, no appointments have been made.

The HIT Policy Committee has made 13 of 20 appointments.

March 19 UPDATE – HIT Standards Committee and HIT Policy Committee

By law, the Office of the National Coordinator for Health Information Technology (ONCHIT) must announce appointments to the HIT Standards Committee and HIT Policy Committee on or before March 31, 2009. ONCHIT has not been forthcoming with news about its progress toward filling these committee posts.

March 12 UPDATE – Continuing Role for CCHIT?

During a webinar today, CCHIT Chair Mark Leavitt said he is confident that HHS will select CCHIT as the certification body identified in the stimulus law because HHS has recognized CCHIT since 2006. He thinks there is not enough time to develop a new certification group because IT systems need to be certified within the next year to qualify for stimulus package bonuses.

March 11 UPDATE – Serve on Standards or Policy Committee

The Office of the National Coordinator for Health Information Technology is seeking nominations to the HIT Standards Committee and HIT Policy Committee, both created under the American Recovery and Reinvestment Act.

The deadline for letters of nomination for both committees is March 16.  The e-mail address is HIT_FACA_nominations@hhs.gov.  The postal address is Office of the National Coordinator, Department of Health and Human Services, 200 Independence Avenue NW, Washington, DC 20201, Attention:  Judith Sparrow, Room 729D.

March 8 UPDATE – National Institute of Standards and Technology (NIST) – Role in Developing HIT and EHR Standards

As part of the Economic Stimulus Package, the NIST will receive approximately $20 Billion to fund its development of HIT infrastructure structure and related standards, including those impacting Electronic Health Records (EHR).  You can access the NIST’s Project Statement here.

Feb. 26 UPDATE – “Billions for health records rest on NIST standards”

Great article from NextGov here.

Feb. 25 Original Post: Federal EHR Incentives – Required Certification

The American Recovery and Reinvestment Act of 2009 (Economic Stimulus Bill) provides financial incentives for physicians and other healthcare providers to adopt electronic health records (EHRs). Physicians, hospitals and health systems will be eligible for the incentives through implementation of their first EHR system or completion of an ongoing EHR project. However, in order to qualify for the incentive payments, a deployed EHR system must be “certified”.

The Certification Dilemma – The certification requirements necessary to qualify for the federal EHR incentives are not known yet and may not be defined until late 2009 (or later). As of today, the EHR certification provided by a nonprofit think tank, the Certification Commission for Healthcare Information Technology (CCHIT), is the closest relevant certification standard in effect. But don’t necessarily rely on that certification to be the one adopted by the federal government when it decides what EHR systems will qualify for the financial incentives.

Stay Informed – On a weekly basis I will be tracking certification standards as they are promulgated by the Office of the National Coordinator for Health Information Technology (ONCHIT), including notice of “comments periods” during which members of the public are invited to comment upon proposed regulations.

If you want to stay abreast of these certification developments, check back often for additional details, or subscribe to the RSS feed below to automatically receive updates.

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Bad RFP – How NOT to Run Your Information Technology RFP Process

Monday, February 23rd, 2009

donkey-buttI helped a small number of clients prepare responses to an information technology RFP issued by the Agency for Heathcare Research and Quality (AHRQ), an agency of the U.S. Department of Health and Human Services, after I posted notice of extension of the bidding deadline and increases to the maximum dollar value of the contracts to be awarded under the RFP. You can view my original post here, and you can view the actual RFP here.

The Project – This huge project involves work to be completed within four (4) major categories (“domains”), and the contracts within each category range from sizeable to jumbo. Skim the RFP yourself to get an idea of scope.

The RFP Document The RFP document itself (not including referenced forms, schedules, rules, attachments, etc.) is 190 pages long and available only as a downloadable document. This is my first criticism. AHRQ should have used an electronic document (eRFP) for this project. More on this below.

Order of Presentation – The first sixty (60) pages of the RFP contain federal procurement boilerplate. Fact is, potential respondents won’t care about any of the boilerplate unless and until they determine they are competent to bid on one or more of the contracts under the RFP. All of this boilerplate should have been placed at the end of the RFP document, or better still, in one or more separate attachments.

AHRQ would have served its needs better by starting the RFP document with a clear and concise description of the overall project and its subparts. Prospective respondents like to see an RFP summary early in an RFP document so they can quickly determine whether they have the high-level competencies necessary to respond. A summary of “category exclusions” would also have been nice. There is no need to force someone to read 80 pages before they figure out they don’t qualify for any work within a particular domain because they lack a critical experiential prerequisite.

Clarity – The clarity and comprehensibility of the RFP document is very poor (in my opinion). Even those well versed in the subject matter of each project domain would have diffuculty understanding the nature and scope of work to be completed for each contract within each domain. The true meat of the contract descriptions does not begin until p. 60 of the RFP, and if a potential respondent would even make it that far (very patient person), they would be disappointed. Where’s the meat? What is AHRQ trying to accomplish?

No Response Template – All of the clients I’ve helped respond to this RFP had the same major difficulty: there is no convenient way to respond. A respondent literally has to create its own method of responding, which means cutting and pasting RFP content, etc. With the technology available today, this is inexcusable. Again, an eRFP would have been the ticket.

No Response Checklist – For an RFP of this magnitude, and especially with all of the federal procurement requirements that apply, AHRQ should have provided a response checklist that covers all required items for any contract under any project domain, as well as required items that are contract-specific. With an eRFP tool, a response checklist is embedded. All required responses, including every required element of each response, are clearly stated, and respondents are prompted to complete entries needing their attention.

What’s the Lesson? – In the broadest terms, the lesson is this. If you want quality vendors to respond to your information technology RFP in numbers (your goal if you want to create a truly competitive bidding process), you have to construct a quality RFP. Tell vendors early on in your RFP what your particular project is about and what technical competencies are required. Also, you need to make it easy for vendors to respond to your RFP. If your process is too difficult or cumbersome, many will give up and never submit a response.

The Bad RFP – Consequences

  • Reduced Vendor Response Rate – Fewer vendors will respond, and for two reasons. One, you’ve made it too difficult for them to respond. And two, a vendor might infer from your disorganized and cluttered RFP that you would not be a preferred client. They might sense they would have difficulty working with you. I assume AHRQ extended the deadline for responding to this RFP because it felt it had an insufficient vendor response to date.
  • Adverse Selection – Quality vendors, those you want to attract to your project, are ususally busy (economic and market conditions obvioulsy produce some variance). They have plenty of work to keep them busy, and they might not take the extra time necessary to respond to your poorly constructed RFP. Lower quality vendors, those who are often less busy, just might find the extra time to respond to your RFP.
  • Deficient Responses – The more difficult it is for a vendor to follow and respond to your RFP, the more deficiencies you will find among vendor responses. When you have to follow up with vendors by issuing follow-on questions and supplements, you increase your internal cost of adminstering your RFP. In the worst of cases, you might have to re-issue your RFP altogether, and if you do this, you may have a dismal response rate the second time around.
  • Scoring Nightmare – A disorganized RFP begets disorganized vendor responses. By not providing a structure for vendor responses, a project sponsor will have a very difficult time scoring them.

Modern eRFX Tool – Second- and third-generation eRFX tools are perfectly suited to managing an RFP of this nature. Vendor inputs can be set up as defined-choice (checkboxes, radio buttons, etc.), narrative, or some combination of both. Vendors have the ability to upload attachments and manage their responsive documents within the tool. Additional required forms and addenda can be attached by the RFP sponsor, making it very easy for vendors to review and complete them when necessary. Vendors have an easy time responding, and the the project sponsor’s scoring effort is very efficient, with numerous and flexible scoring and weighting options available.

Comments – My criticism here of AHRQ’s RFP process is pretty harsh. I realize that. AQHR representatives may have several things to say in defense of AQHR’s process, and those comments are welcome. My goal is not to beat up on AHRQ, but rather to provide an opportunity for all of us who touch information technology procurement to learn. And that includes yours truly.

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Economic Stimulus Package – Finalized Bill – EHR Incentives

Friday, February 20th, 2009

medical-records1Finalized Bill – President Obama has signed into law the American Recovery and Reinvestment Act of 2009. You can view the text of the signed bill here.

Authorized Incentives for Use of EHR Systems – The incentives total over $17 Billion and will be adminstered through Medicare and Medicaid as reimbursements over a 5-year period as follows.

    Hospitals – Hospital incentives start at $2 Million annually, with an additional reimbursement amount tied to annual Medicare discharge volume, and decrease for each subsequent year during the 5-year incentive period.

    Physicians – Non-hospital-based physicians and physician groups can expect to receive up to $60,000 during the 5-year incentive period, including $18,000 the first year, if they have qualifying EHR systems in place by 2011.

EHR Systems That Qualify for the Incentives – Qualifying EHR systems (tied to “meaningful EHR users”) must meet the following criteria.

    Clinical Decision Support – As yet undefined, but presumably includes, for example, drug allergy and drug interaction tracking capability

    Physician Order Entry (CPOE) – As yet undefined, but presumably includes the ability to order lab tests, prescriptions, etc., electronically.

    Ability to Capture Health Care Quality Data – “To capture and query information relevant
    to health care quality.” As yet undefined, but the legislative history suggests concerns over those “underserved” within the U.S. healthcare system.

    Ability to Support the Exchange of Clinical Data with Other Organizations – As yet undefined, but will presumably include elements of system interoperability.

The definition of a “qualifying EHR system” is relatively soft right now (meets the above criteria and is CCHIT-certified), but the definiton will become more onerous as we move further into the 5-year incentive period. The Office of the National Coordinator for Health Information Technology (ONCHIT) will be issuing regulations over time that will define additional qualifying criteria and certification standards.

Other Sources of Funding – ONCHIT will have approximately $2 Billion to make low-interest loans and grants available with respect to EHR. Eligibility standards have not been established, but the legisative history suggests the these dollars will go to the states and perhaps private sector participants for the development of EHR system and interoperability standards.

Buy Now, Upgrade Now, Or Wait? – Excellent question.

Reasons to Wait

    State of Flux – Just like you, EHR system vendors are anxiously awaiting the new EHR system qualification criteria, including any new certification standards. They cannot develop to compliance until the new compliance requirements are known. So, you might decide to wait for the regulatory dust to settle before you buy your first EHR system or upgrade to a new system.

    Buy Now, Get Reimbursed Later – With the after-the-fact reimbursement structure of the EHR incentive program, you may find that you do not have sufficient money of your own right now to invest in an EHR system. And even if you do, you certainly don’t want to waste money on a system that might not qualify for incentive reimbursements down the road (as ONCHIT changes the rules of the game over time).

Reasons NOT to Wait

    Planning and Sourcing Take Time – Think of it this way. There are over 300 EHR system vendors out there, and your attempt to understand the functional and technology-environmental variations among the current vendor offerings could make your head spin. Add your attempt to factor in an uncertain future with respect to qualification and certification standards, and you’ll quickly find yourself overwhelmed.

    My point is this. If you want to take advantage of the EHR incentives, you better get started NOW. You don’t necessarily have to commit to a buying decision now, but you should start your planning process now. Get informed, stay informed. Don’t procrastinate.

    Reimbursement Penalties – Remember that the stimulus bill includes not just incentives for EHR system adoption. It also includes penalties. Starting in 2015, healthcare providers that have not adopted a qualifying EHR system will face cuts in their normal Medicare reimbursements.

    EHR System Vendor Terms and Conditions – You can address the uncertainty within the EHR system market place by demanding tough terms and conditions from your EHR system vendor. You want your EHR system to be a qualifying system when you buy it, and it’s fair to expect that your vendor will warrant its qualifying status over time. Under the present circumstances, EHR vendors realize they will have to be extending some very buyer-favorable terms and conditions in order to sell their systems. Take full advantage of this situation, but remember one thing. Good terms and conditions, including system warranties, are only as good as your vendor’s ability to back them up. Larger, more-established vendors may have more financial wherewithal to support the buyer-favorable T&C they extend over time. Smaller shops may not.

EMRmatch – Objective EMR Selection Tool

Friday, February 13th, 2009
Definitive EMR selection tool, matching EMR buyers and vendors.

Click here to learn more about EMR Match™.

Not Like the Others – If you have tried other EMR selection tools or evaluators, you may have been disappointed for any number of reasons: 1) you thought the tool was objective and unbiased, but you found later that it is sponsored by an EMR vendor or multi-vendor reseller; 2) the selection criteria were too few or too many; or 3) your search for an EMR vendor was not narrowed sufficiently or it was narrowed too much. Your inital disappointment may have led to outright frustration in the form of unsolicited calls from EMR vendor salespersons.

EMRmatch is different. VERY different!   EMRmatch has no ties to EMR software or ASP vendors and does not accept any commission, referral or finder’s fee from any EMR vendor or reseller. EMRmatch is entirely objective and unbiased.  Further, the classification criteria within EMRmatch range beyond those within the other available EMR selection tools, whose classification criteria are limited to the typical EMR functionality points. You want to know how a given EMR solution will fit into your particular technical environment, and whether the necessary application support is covered by your existing resources.  EMRmatch helps you with this important element of your EMR buying decision.

Extended EvaluationEMRmatch transitions seamlessly over to EMRselect, a sophisticated electronic procurement tool that lets you interface with the EMR vendors you choose.  You do not have to contact any vendor until you are ready, and you can remain anonymous to vendors for as long as you choose.  As you move closer to a buying decision, you can use EMRselect‘s electronic RFI and RFP features to streamline the final stages of your vendor selection process.

Integration Support – After you have purchased your new EMR system, you can use EMRconsult to identify competent independent consultants who can assist with your installation, configuration and implementation needs.  In most cases you can buy these additional services from your software vendor or reseller. EMRconsult simply gives you more choices.  More choices increase your odds of finding the best EMR implementation expert for your needs.  And finding the right expert can result in better implementation results, within a shorter timeframe, and with reduced impementation expense.

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Senate Approves Economic Stimulus Bill

Tuesday, February 10th, 2009

View the February 20, 2009 UPDATE to this post here.

The Vote – The Senate voted 61-37 to approve an economic stimulus bill that’s expected to cost $838 billion through 2019, according to the latest estimate from the Congressional Budget Office.

Work That Remains – The Senate will have to work with the House to settle differences between the approved Senate version of the bill and the $820 billion House version. Hopefully, those differences will be resolved expeditiously. A finalized version of the bill will be presented to Obama for his signature.

Text of Senate Bill – You can view the text of the Senate bill here.

EHR Incentives – Good news! The EHR incentives under TITLE IV—HEALTH
INFORMATION TECHNOLOGY, Subtitle A—Medicare Program, remain intact.

Preservation and possible creation of HIT jobs also remains intact. I am very pleased with this outcome. If you are, too, shout out to others by commenting below.

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UPDATE – Economic Stimulus – HIT and EHR

Monday, February 9th, 2009

View the February 20, 2009 UPDATE to this post here.

Despite a vote to occur within the Senate in less than 24 hours, the text of consolidated Senate revisions to HR1 is not yet available. However, this from the United States Senate website, updated February 9, 2009. Presumably, this is the most recent (current) version of the Senate amendment affecting incentives available to EHR adopters.

Senate Amendment 570 to HR1 (scroll down to S.A.570) still contains the following language, verbatim, from HR1 regarding incentives for provider adoption of EHR:

“(B) LIMITATIONS ON AMOUNTS OF INCENTIVE PAYMENTS.–

“(i) IN GENERAL.–In no case shall the amount of the incentive payment provided under this paragraph for an eligible professional for a payment year exceed the applicable amount specified under this subparagraph with respect to such eligible professional and such year.

“(ii) AMOUNT.–Subject to clauses (iii) through (v), the applicable amount specified in this subparagraph for an eligible professional is as follows:

“(I) For the first payment year for such professional, $15,000 (or, if the first payment year for such eligible professional is 2011 or 2012, $18,000).

“(II) For the second payment year for such professional, $12,000.

“(III) For the third payment year for such professional, $8,000.

“(IV) For the fourth payment year for such professional, $4,000.

“(V) For the fifth payment year for such professional, $2,000.

“(VI) For any succeeding payment year for such professional, $0.

So, despite the headlines depicting broad HIT spending cuts by the Senate, it appears this little chunk of spending will be carried forward into the compromise bill.

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Senate Version Of Economic Stimulus Package – HIT and EHR Incentives

Saturday, February 7th, 2009

View the February 20, 2009 UPDATE to this post here.

UPDATE – See the February 9, 2009 UPDATE to this post here.

The current Senate version of HR1, the “American Recovery and Reinvestment Act of 2009″, increases the amount of incentives available for EHR adoption. (Section 4201)

Status Quo Plus More EHR Incentive Dollars For Rural Eligible Professionals

“Eligible professionals” (which does not include “hospital-based professionals”) who are “meaningful EHR users” can receive up to $41,000 in EHR incentives over five (5) years. This provision is identical to the HR1 provision. Adding a new twist, “rural eligible professionals” are eligible for an additional 25% over the amount available to non-rural eligible professionals.

You can view the text of the Senate version of HR1 here. The EHR incentive provisions begin at Page 648.

The Senate will vote on its version of HR1 as early as next Tuesday.

So far, so good, for HIT and EHR within the economic stimulus package.

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HHS – Agency for Healthcare Research and Quality (AHRQ) – Revised Bid Solicitation

Friday, February 6th, 2009

Last month, AHRQ issued a solicitation for proposals for multiple IDIQ/Task Order contracts through which individual Task Orders will be awarded to maintain, serve, and support the AHRQ National Resource Center for Health Information Technology.

Today, AHRQ announced that it has modified the ceiling amount for all contracts (including options) to $300 Million instead of the previously stated $75 Million. Individual ceiling amounts will be established for each base contract awarded based on the anticipated level of work required under each of the following four domain areas:

    1. Support for HIT Program Management, Guidance, Assessment and Planning

    2. HIT Technical Assistance, Content Development, Program Related Projects and Studies

    3. HIT Dissemination, Communication and Marketing

    4. HIT Portal Infrastructure Management and Website Design and Usability Support

In addition, AHRQ has extended the due date for receipt of proposals to February 26, 2009, at 12:00 PM EST. Also listed in the amended solicitation are responses to questions that have been received as a result of the Requests for Proposal. View the amended solicitation.

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Incentives In Stimulus Could Benefit Software Vendors Less

Thursday, February 5th, 2009

View the February 20, 2009 UPDATE to this post here.

ASP EMR To Gain Preference? – According to Bloomberg News, the economic stimulus bill approved by the House last week favors health IT firms that operate on an application service provider model over software vendors.

ASP Less Expensive Up Front – The House’s $819 billion economic stimulus package includes $20+ billion for health IT. The bill would provide financial incentives to physicians over time, rather than upfront, lump sum payments. This means doc’s and hospitals will likely opt for a less-expensive ASP EMR solution, versus investing in a locally-installed software package that is relatively more expensive to buy. Or so Bloomberg’s logic goes.

I Don’t Necessarily Agree – On the surface Bloomberg’s logic seems sound, but let’s face it. There’s a lot more to an EMR buying decision than initial cost.

Internet Interruptions – If I’m a doc’, and I’m about to make the leap to managing my practice electronically, I’m certainly going to think about the reliability of the sytem I choose. What if my internet connection goes down, or the speed of my connection bogs down to a snail’s pace? Am I supposed to stop seeing and scheduling patients, and stop prescribing their med’s, until my connectivity is restored?

Security – With all of the state and federal onus placed on practitioners and healthcare facilities to protect and secure patient health information, is it wise to allow such information to vaporize into the web cloud? I would love to see the indemnification provisions contained in an ASP EMR license agreement and the ASP’s terms of service. If anyone has an example, please do forward it on.

Long-Term Value – The fee basis for many ASP EMR arrangements is tied to revenue. Is it better to make a somewhat larger investment upfront, depreciate it over several years, and own it outright? Or, better to make the smaller upfront investment and share revenue indefinitely? I think many EMR buyers will opt for ownership and control of their EMR system.

Initial Costs – Lastly, another flaw in the Bloomberg analysis is the fact that locally-installed EMR systems (software versus ASP) are just not that expensive. You license the software, maybe buy some additional hardware, and it’s off to the races. For a small office practice, initial cost estimates for an EMR system vary from $3,000 to over $40,000. Certainly, wise buyers will do just fine with investing at the smaller end of this range. In the current House bill, independent (not hospital-based) providers can receive up to $15,000 in 2009, and a lesser amount each year thereafter, during a total incentive period of five (5) years. In my mind, the current incentive figures are more than adequate to support purchase of a locally-installed EMR system.

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HIT Amendments Expected in Senate Economic Stimulus Bill

Wednesday, February 4th, 2009

View the February 20, 2009 UPDATE to this post here.

UPDATE – See the February 9, 2009 UPDATE to this post here.

As the Senate works on its version of the Economic Stimulus Bill, CongressDaily is reporting the following amendments to the House version of the bill.

Reduce HIT Spending – So far, a reduction of the amount of HIT spending and incentives has not been attacked in the Senate. Good news for those of us who work within and touch HIT.

Health Care Disparities – In an effort to eliminate healthcare disparites, this amendment would require that electronic health records collect information on race, ethnicity and gender.

Health Privacy Violations – Changes would allow state attorneys general to file class-action lawsuits against violators of federal health privacy laws, and prohibit states from hiring outside lawyers on a contingency basis to ensure that damages collected are returned to taxpayers.

Data Breach Notification – Changes are aimed at closing loopholes that would in many cases prevent consumers from knowing if their medical information has been improperly accessed.

Quality Initiatives – An amendment that would exempt quality initiatives, such as disease management and care coordination efforts, from a provision that requires the HHS secretary to issue new health care operations rules.

So, thus far, all good news in terms of maintaining substantial funding for HIT. This happens to be the objective that I care about most right now–a good chunk of HIT spending that is cemented into the final bill. We can worry about the peskier of details later, in my opinion.

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