D.C. Report: HIT Policy Committee Update, Entitlement Spending Largely Spared in Debt Deal

HIT Policy Committee Update CMS Analyzes Early Attesters, Updates Year-to-Date MU Stats According to CMS officials who spoke during the Health IT Policy Committee Wednesday, 77,000 providers have registered for the EHR incentive payments, receiving nearly $400 million through July. Among them, some 100 hospitals have successfully attesting under Meaningful Use and no hospital has yet failed to meet minimum thresholds, the officials noted. In an analysis of early attesters (.pdf), CMS officials said the most popular menu objectives were drug formulary, incorporating lab test results & patient list. The least popular menu objectives included Medication reconciliation & summary of care record.

Also this week, two states—New Mexico and Wisconsin—began their Medicaid EHR incentive payment programs to receive provider registrations, bringing the total to 23 states. For the latest facts and figures out from CMS for Meaningful Use attestation, click here (.pdf).

Entitlement Spending Largely Spared in Debt Deal…For Now According to the latest reports and analysis, the Budget Control Act (aka the debt ceiling deal) will spare Medicare and Medicaid during the first round of cuts made over the next decade. Discretionary spending under the new law will reduce outlays by $917 billion over the next ten years; meanwhile a joint select committee will convene to find another $1.2 billion in deficit reduction over the same period. In the first round of cuts ($917 billion) Medicare and Medicaid were left untouched so the cuts will have to come from other sources of discretionary spending. However, the second round of cuts—made either through new legislation crafted by the select committee or through a “sequestration” mechanism—are not likely to spare the entitlement programs from changes.

Joint Select Committee
Under this scheme, both Democrats and Republicans would choose six members to sit on the committee. Seven votes would be required to report recommendations and they will have between August 16 and November 23 to pass recommendations to Congress. Both revenue increases and entitlement cuts will be “on the table” during these negotiations, but observers note that the political climate is not likely to yield recommendations containing both strategies. If by Jan.15, 2012 the joint committee’s recommendations have not been enacted into law, a sequestration mechanism will mandate cuts to defense and nondefense spending.

Sequestration
According to the terms of the automatic trigger, savings would be spread evenly over the nine years 2012-2021 to mandatory and discretionary spending in both defense and nondefense spending. Among those areas, grants to states for Medicaid would be exempt from the sequester, along with Medicare Part D Low income subsidies; payments to states for subsidies for certain low income Medicare beneficiaries; and Social Security benefits. What this means is if the sequester mechanism is put into play and the exemption estimates are accurate, the percentage reduction in the remaining defense and nondefense programs would bear the brunt of cuts.

General Medicare payments are not exempt from the sequester, but they are limited to reductions of no more than 2 percent for any fiscal year. And hospitals are already on the hook for more than $155 billion in cuts over the next 10 years due to the Affordable Care Act.

Bills Look to Extend MU Incentives to Physician Assistants New legislation out this week would extend EHR Incentive Payments to physician assistants who see more than 30 percent Medicaid patients. According to the Health IT Modernization for Underserved Communities Act (.pdf), physician assistants who meet certain requirements to qualify for incentive payments under the meaningful use program and work in rural health clinics or federally qualified health centers would be eligible. Currently, the HITECH Act offers incentive payments to physicians and nurse practitioners who provide primary care to the requisite 30 percent threshold of Medicaid patients, but not PAs. Reps. Karen Bass (D-CA) and Lee Terry (R-NE) introduced H.R. 2729 August 1.

Successful HIEs Share Common Strategies, Says NeHC According to a new report released in Washington this week, several leading health information exchanges (HIEs) share a common set of “critical success factors.” The National eHealth Collaborative (NeHC) studied 12 HIE organizations from across the U.S., including for-profit, not-for-profit and one government HIE. In its report, “Secrets of HIE Success Revealed: Lessons from the Leaders,” NeHC identified five major components shared by the successful HIEs, including (1) the ability to align stakeholders with HIE priorities; (2) establishing a brand for the HIE that is seen to be neutral; (3) focusing on value propositions for investment; (4) understanding unique market structures as well as (5) understanding the clinical aspects of the HIE’s clients. The report also looked at common barriers including patient privacy and consent issues; interoperability issues, competition and trust. According to officials, the NeHC University (an education and outreach program sponsored by the ONC) will offer in-depth case studies and roundtable discussions with HIE leaders in future sessions. This report comes on the heels of two other reports, one by research firm KLAS and another by the eHealth Initiative, which are adding definition to the HIE landscape two and a half years after the passage of HITECH.