What if the Home Mortgage Interest Deduction Looked like Meaningful Use?

Posted on November 11, 2010 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.


Recently I was preparing a lecture to our state specialty society on Meaningful Use / HITECH incentives.  During my research I was again disgusted by typical government intervention at work.  The Feds took a simple and worthy idea – encouraging physicians to adopt EMR – and made it as complicated and burdensome as possible.

They should have modeled EMR incentives after effective, relatively simple government incentives that already exist, such as the home mortgage interest deduction.  Ironically, this deduction is now under fire from the Deficit Commission.  If you pay mortgage interest on a home you live in, you can deduct the interest from your taxable income.  I know it’s more complicated but that is pretty much the idea.

What if home mortgage interest deduction rules looked like HITECH rules?

  1. The incentive would be fixed payments, not a variable payment based on expenses.
  2. The people living in your home would have to be “Eligible Occupants.”
  3. Your home would have to be a “Certified Dwelling.”  There would be hundreds of pages of specifications for Certified Dwellings.  An entire industry would spring up dedicated to getting your home certified.  After spending the money to get your house up to specifications, a federal certification agent would visit your home (after a several month wait) and hopefully provide certification if your house meets the requirements.  Because many of the rules would be ambiguous and unclear, certification would depend quite a bit on the agent’s judgment.  No potential for corruption there…
  4. Next you would have to demonstrate “meaningful occupancy.”  There would be a required minimum number of occupants.  Each occupant would have to sleep in the house a minimum number of nights per year.  Doesn’t take much imagination to make the list of requirements go on forever.  And not only would you have to follow all these rules, you would have to document it somehow.
  5. Finally you would have to report on Quality Measures for your home such as electricity and water use.  You would also have to report on Quality Measures that do not apply to your home, i.e., homes with electric heat would still have to document natural gas use.  This would require running a gas line and gas meter to your house even if you don’t use gas.
  6. You would have to do all of the above every year in order to get the incentive.  Failure to meet any of the above requirements would mean no incentive payment.
  7. All the above specifications would get more stringent every year.  But the incentive payment would go down and be phased out completely after 5 years – even though mortgages go on for 30 years in most cases.

New homes would be designed not for comfortable living but to satisfy Certified Dwelling and Meaningful Occupancy requirements for as little money as possible.

At some point the incentive becomes more trouble than it is worth.  Maybe it would be smarter to go the other way and make Meaningful Use rules look like the mortgage interest deduction:  Tax credits up to $20k per provider, enhanced tax deductions for expenses beyond that.  But that would be too easy.