D.C. Report: HHS Budget Wrangle, NwHIN Ponders ONC Standards Recommendations, Medicare Smart Cards, HIE Sustainability
Senate Reaches Deal On HHS Budget, House Stalls; Continuing Resolution Fails Last week appropriators in both chambers of Congress took up bills to fund the Department of Health and Human Services. The Senate Appropriations Subcommittee on Health voted along party lines to pass a $158 billion spending bill for HHS, Labor and Education this week. The price tag falls $308 million short of the fiscal year 2011 totals, but Senate Republicans balked at the $4.5 billion for provisions of the Affordable Care Act (ACA). After Tuesday’s Subcommittee vote, the full Appropriations Committee voted on the HHS specific portions of the bill and passed a party-line vote that would cut HHS funding by less than 1% to $70.18 billion from $70.44 billion. In President Obama’s budget request, he had sought $79.9 billion for fiscal year 2012.
On the House side, Health Subcommittee members of the GOP are rumored to be holding up the HHS spending bill due to cost concerns. Reps. Jeff Flake (R-Ariz.) and Cynthia Lummis (R-Wyo.), sent a letter to House leaders urging them to make sure spending limits on all appropriations are in line with the amounts proposed by Budget Committee Chairman Rep. Paul Ryan (R-Wis.) instead of the debt ceiling deal. Under the Ryan budget, spending for health, education and labor programs would have been set at $139 billion, an $18 billion cut over this year’s levels. The new subcommittee bill, which was never announced and has been repeatedly delayed, is expected to be somewhat higher.
Finally, the House of Representatives voted 195-230 this week to reject a continuing resolution (CR) funding federal programs through November 18. Congress must reach agreement on a CR by October 1, the start of Fiscal Year 2012, to avoid a government shutdown. This continued pattern of partisan squabbling over budgets shows little has changed since last summer’s debate over the debt ceiling. Meanwhile the Super Committee takes up even broader spending and deficit matters amidst this contentious atmosphere.
National Health Information Network Gets Look from ONC Advisory Committee The Nationwide Health Information Network (NwHIN) Power Team held a meeting this week to discuss draft recommendations for the ONC’s HIT Standards Committee. The NwHIN Power Team convened over the summer to evaluate and identify specifications generated by two pilots ( Exchange and Direct) that:
• Introduce significant deployment, operational and administrative complexity and have low industry adoption
• Are in early or moderate stages of development, and the technologies used are in a declining phase of their life-cycle
• Provide capabilities for which the business need is “Low”
According to the Power Team’s assessment, several of the specifications identified through Exchange and Direct have “high” to “moderate” business needs, with most of the technologies in a mature development phase. However, when surveying the deployment complexity and industry adoption rates, the Power Team acknowledged that we have a long way to go. Draft recommendations (.pdf) discussed during the meeting said, “Neither the Exchange specifications nor the Direct specifications have been adopted beyond their pilots. The scalability of the underlying architectures, and inherent impacts on workflow, need to be better understood before these specifications are codified into regulations.” The “Conclusions and Recommendations” go on to say, “The Exchange specifications are highly complex, and designed to support an architecture that may not be appropriate for all healthcare organizations, and that may not scale to nationwide implementation.” Of particular complexity are specifications related to Patient Discovery. “[It’s] problematic and cumbersome, and presents a serious challenge to scalability beyond a limited pilot; patient matching challenges disrupt provider workflow.”
Senate Bill Proposes to Use Smart Cards for Medicare Beneficiaries A new bill authored by Senator Mark Kirk (R-Ill.) requests the Secretary of Health and Human Services to launch a pilot program to test the utilization of smart card technology for Medicare beneficiaries and provider identification cards to (1) increase the quality of care furnished to Medicare beneficiaries; (2) improve the accuracy and efficiency in the billing for Medicare items and services furnished by Medicare providers; (3) reduce the potential for identity theft and other unlawful use of Medicare beneficiary and provider identifying information; and (4) reduce waste, fraud, and abuse in the Medicare program. The bill stipulates that five test sites be setup using smart card chip, biometric and other technologies to achieve the four aims mentioned above. Sens. Lamar Alexander (R-Tenn.), Marco Rubio (R-Fla.) and Ron Wyden (D-Ore.) are cosponsors to S. 1551.
State CIOs Look at HIE Sustainability A new issue brief released by the National Association of State Chief Information Officers (NASCIO) says that a sustainable funding model for state-run health information exchanges (HIEs) is “paramount” as federal funds dry up. The issue brief says (.pdf) that despite substantial leeway afforded to states to develop sustainable models for HIE, State CIOs need to assert themselves in identifying business drivers that will push revenue above costs for exchange. Funds made available through the State HIE Cooperative Agreement Program, through its $550 million in grants, have gone a long way in addressing upfront planning and implementation costs, but other costs including hosting services, data center, administrative and operational will be a major challenge moving forward. The brief identifies three models based on fees for their members to consider: transaction fees, subscription fees and a hybrid model that use subscription fees for core services and transaction fees for value added services.
One other option identified in the brief is the “HIE as a Public Good” model. This model would do away with stakeholder contributions and would require the public to support the exchange of health information through a state tax or fees. However, the report acknowledges that “the likelihood of state governments enacting legislation that would push the burden onto the constituents and businesses is unlikely.” Moreover, NASCIO believes the “current political environment and looming economic trepidations in the states” make fee models with key stakeholders more attractive to policymakers.
