Washington Debrief: Bill Would Shield EHR Penalties for Certain Docs

April 16, 2013
Word of a bill spread throughout the health IT community recently that would shield some eligible professionals from “payment adjustments” for failing to meet meaningful use in 2015 and beyond. Sometimes the grapevine is a good place to hang out.

Bill Looks to Shield Certain Docs from EHR Penalties Word of a bill spread throughout the health IT community recently that would shield some eligible professionals from “payment adjustments” for failing to meet meaningful use in 2015 and beyond.  Sometimes the grapevine is a good place to hang out.

The EHR Improvements Act (H.R.1331), sponsored by Representative Diane Black (R-Tenn.), would create two new exemptions for Medicare-participating eligible professionals:

  •          The first would allow solo practitioners (small practices with one physician) to qualify for a hardship exemption because of limited capital, time, and staff resources; and
  •          The second would allow physicians who will be eligible for Social Security by 2015 to qualify for a retirement exemption of no more than three years. 

Beyond these exemptions, the EHR Improvements Act makes a number of changes to HITECH to “reduce the regulatory burden for providers; reduce cost per practice in establishing EHRs; and tailoring ‘meaningful use’ requirements to better meet the needs of providers and patients,” a bill summary from Rep. Black’s office states.  Some of these other changes include:

  •          Shortening the gap between the performance period and the application of the penalty to no more than one year.  (There is currently a two-year look-back.)
  •          Expanding the options for participation and improving quality measures by using specialty-led registries.
  •          Including rural health clinics as “eligible professionals (EPs)” under the Incentive Program.
  •          Instructing CMS to establish a formal appeals process before the application of the penalties.

The bill is currently before the Ways & Means and Energy & Commerce Committees.

**Public Policy Announcement** CHIME MU Survey Now Open! Just in case you missed it, CHIME is conducting a Meaningful Use survey to understand how CIOs are meeting MU requirements and the rate they are qualifying for payments.  As we approach the beginning of Stage 2, it is vital that we have a high response rate indicating where the industry is in its implementation of 2014 Edition EHRs.

We will be presenting this information during an event being held May 7 in Washington to Members of Congress, their staff and invited members of the federal government (ONC, CMS, NIST, etc.).  These survey results - because it's coming from the nation's CIOs - will have an immediate and powerful impact on the direction of Meaningful Use and the timing of subsequent stages.

Please click here to take the survey (it's only 7 questions).  And make sure your colleagues take the survey as well.  URL here: http://www.cio-chime.org/members/surveys/MUSurvey2013.asp

Health IT Policy Committee Looks at ‘Interoperability’ This month’s meeting of the Health IT Policy Committee was focused on the recently-released joint request for information (RFI) from CMS and ONC.  Several issues were tackled through updates and recommendations given from workgroups and officials from the two agencies.  The meeting began with an overview of the CommonWell Health Alliance – the six-member industry consortium newly formed to “adopt common standards and protocols to provide sustainable, cost-effective, trusted access to patient data…available across vendors and delivered ‘out of the box’” to providers.  An independent and objective look at what CommonWell is proposing to do and how they propose to do it was delivered by HITPC membersPaul Egerman and Charles Kennedy.  The Committee responded with questions about whether the technology offered between the six vendors (and later by vendors who join) would be a severable service, or an exclusive network (enforced through technology or governance).

Additional presentations addressed questions of the RFI, including a presentation from the Information Exchange Workgroup.  Recommendations from the IE WG focused on issues that either hurt interoperability or could be a boost to interoperability.  Some of the areas of focus included payment policies, Meaningful Use eligibility, state-level program and policy variations and HHS infrastructure.

Others presented information to inform the RFI generally, such as the Privacy & Security Tiger Team, or give updates on the progress of adoption.  CMS gave their monthly update on registration and attestation numbers, meanwhile the Office of Provider Adoption Support (OPAS) gave an overview of REC activity and EHR adoption.  Here is a listing of all the presentations given during this month’s meeting.

Three-phase Plan to Repeal SGR Takes Shape in House Leaders on the House Ways and Means and Energy & Commerce Committees unveiled an updated plan for a permanent “doc fix” this week.  The plan outlines a three-part strategy to transition physicians away from the sustainable growth rate, using a mix of performance-based formulas.  “Based on respondent input, we envision a system where providers have the flexibility to participate in the payment and delivery model that best fits their practice,”  four Republican lawmakers wrote in a letter to providers. “The overarching goal is to reward providers for delivering high-quality, efficient health care, whether in a FFS system or in an alternative payment model program.”  The plan foresees a repeal of the SGR formula during the first multiyear phase where physicians would get a series of stable payment updates.  In the second phase, payment levels would come from a base rate, plus a variable rate tied to the physicians’ performance on several quality measures relative to their peers, improvement over last year’s quality score and doing clinical improvement activities.  In the third phase, payment rates would be based in part on quality measures, adjusted for risk and severity of illness treated.  In addition, providers who meet a minimum quality score would be able to earn additional incentive payments based on their efficient use of resources.

This plan tracks, in many ways, with similar legislation released earlier this year by Representative Allyson Schwartz (D-Penn.) on taking a phased approach.  House leadership hopes to have a bill to vote on sometime this summer.

Confirmation for Acting CMS Head Set After serving as Deputy Administrator and then Acting Administrator at CMS for more than three years, Marilyn Tavenner has her first shot at confirmation.  Tavenner will get a confirmation hearing in the Senate April 9.  If she is confirmed, Tavenner would become the first Senate-approved CMS leader in over seven years.  Observers note that the Acting Administrator has strong support from the provider community and has tentative bi-partisan support, where Senate Finance committee Chairman Max Baucus (D-Mont.) and senior Republican Orrin G. Hatch (R-Utah) have predicted a smooth process.  But that is not to say the hearing will be an easy one.  A rash of recent rules surrounding implementation from the ACA has irked several members of Congress and there are still active calls for repeal of Obamacare coming from Senate Minority Leader Mitch McConnell and others.

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