D.C. Report: MU Stage 2 Timeline, HHS Policy Hearings, Partnership for Patients

Options Weighed for Meaningful Use Stage 2 Timeline. At a meeting held this week, the HIT Policy Committee Workgroup on Meaningful Use reviewed comments received from over 400 stakeholders for Stage 2. Central to Tuesday’s discussion was how to address concerns about the timeline of attesting to Stage 2 MU. The workgroup highlighted four possible paths:
1. Maintain current timeline and one-year reporting period; or
2. Maintain current timeline and permit 90-day reporting period; or
3. Delay transition from stage 1 to stage 2 by one year (providers could get third-year payment for meeting stage 1 expectations); or
4. Phase-in approach that separates existing from new functionalities
a. 2013: Updated stage 1 requirements (“Stage 1 Prime”) with no new EHR functionality (e.g., move menu set items to core and increase thresholds of existing stage 1 functionality measures)
b. 2014: Stage 2 objectives requiring new EHR functionalities would not be expected to be implemented until FY 2014

Workgroup chair Dr. Paul Tang/Palo Alto Medical Foundation indicated he might be open to the idea of delaying Stage 2, but that it would come at a cost to providers who attest this year. “It only affects one group, the group that comes in, in 2011. Because of the way the rule is written, those people would be subject to a loss of one year’s incentive,” he said. Additionally, Tang acknowledged that a delay would give providers a third year to meet Stage 1 requirements, instead of two, and could increase overall participation in the EHR Incentive Payments program. Final recommendations for measures will be submitted to the full HIT Policy Committee next week and timing recommendations will issued in June. Also discussed at Tuesday’s meeting was a letter of recommendations for Stage 2 submitted by the Information Exchange Workgroup. Among the topics addressed in the letter were: Patients’ Ability to View/Download Information; Medication Reconciliation; and Longitudinal Care Plans & Care Teams.

Hearings Focus on HHS Policies and SGR Fixes. In a week filled with multiple hearings on health and related topics, health IT was one of many issues, though not a major focus. In testifying before the House Education and Labor Committee on the 2012 HHS Budget priorities, HHS Secretary Sebelius reported on the Medicare and Medicaid Incentive Program, noting that the first of the Medicaid incentive payments were made on January 5, 2011. As of March 31, 660 providers had received $64 million in Medicaid incentives. An increase of $17 million in ONC’s budget has been requested for FY 2012 for purposes of assisting providers to become meaningful users of health IT. Of questions directed to the Secretary, The Accountable Care Act drew the most attention from lawmakers.

House Energy and Commerce Health Subcommittee Chair Joe Pitts (D-PA-16) opened this week’s hearing on the SGR by summarizing 2010 and recent activity on Medicare physician payment: “Congress passed two 1-month overrides, two 2-month overrides, one 6-month override and, most recently, for 2011, Congress passed a 1-year override. All this was done without resolving the underlying problem. Meanwhile, the cost of fixing the problem continues to grow.” Former CMS Administrator Dr. Mark McClellan kicked-off a panel of witnesses that included the Coalition of State Medical and National Specialty Societies, AMA, American College of Surgeons, American Academy of Family Physicians and MedPAC. McClellan observed that as CMS Administrator five years ago he had testified on this topic many times. “We are in a better position to fix the problem than ever before,” he said. “Legislation including the Medicare Modernization Act and the Affordable Care Act has created or enhanced initiatives that help lay the foundation for needed payment reforms in Medicare, as have reforms in states and the private sector. They include paying more when physicians use health IT to actually improve care, and when physicians report on and achieve better quality of care.”

Senate Committee Discusses Healthcare Quality and Patient Safety. The Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing yesterday to discuss HHS’ new Partnership for Patients initiative, of which CHIME is a partner. Committee Chair Sen. Tom Harkin (D-IA.) said, “We need bold action,” during his opening comments, citing statistics that indicate one-third of patients suffer medical errors or other adverse events that could be avoided during a hospital stay.

Sen. Barbara Mikulski (D-MD), who serves as the Committee’s resident expert on healthcare quality issues, said that ACA had four components that emphasized quality principles, the first of which was the introduction of health IT. “We wanted to introduce health IT [to show] that it really provided a new way of keeping track of patients and keeping track of care. And we also wanted to have health interoperability so we wouldn’t have a techno-disaster.” Another of the four components was evidence-based practices, which was the topic of choice for testimony given by Timothy L. Charles, President and CEO of Mercy Medical Center in Cedar Rapids, Iowa. “With each successive year, blending technology and LEAN process improvement the hospital environment has become safer and more reliable,” Mr. Charles said “Process improvement coupled with advanced technology – from robotics in the pharmacy, computerized SMART IV pumps, bed-side medication verification and bar coding, vocera communications systems – the organization has grown in its sophistication.”

But not everyone was as optimistic about the amount of lives and level of cost savings that are purported to come through quality improvement efforts. Ranking member, Sen. Enzi (R-

WY) criticized government for spending a billion dollars to support pilot projects through the CMS Center for Innovation. AHRQ has been publishing best-practices for years, he said, “but efforts to fundamentally transform systems of care to promote quality and lower costs remain almost an aspirational goal.” In contrast, Sen. Mikulski said she thought the $1 billion price tag was “a bit thin” and urged colleagues to devote more funds to the program.