D.C. Report: ONC Standards Committee Meets, New Primary Care Payment Initiative

ONC Standards Committee Looks at Host of Recommendations in Final ‘Summer Camp’ Meeting Wednesday marked the end of summer for ONC’s Health IT Standards Committee (HITSC). During the past six months, a panel of sub-workgroups—collectively known as Standards Summer Camp—have been working on issues related to metadata, patient matching, syndromic surveillance, and specifications for the nationwide health information network (NwHIN). This month’s HITSC meeting reviewed the various Summer Camp recommendations and conclusions with opening remarks being made by Dr. Farzad Mostashari. Dr. Mostashari was forceful in his call to action for the Federal Advisory Committee to push forward with standards that are “good enough” to get started on health information exchange, rather than waiting until they gain maturity and wide adoption. “My request to you is to push. There is a sense in which not moving on anything is a greater risk than moving forward on something that may be imperfect,” Mostashari said. “We can’t afford to wait another five years before we have exchange in this country.” These remarks come amid widespread commentary from CHIME (.pdf), AHA, FAH, HIMSS and other health IT leaders that standards under consideration by the ONC for metadata should be further considered and pilot tested before being codified into law.

HITSC’s meeting Wednesday covered much more ground than simply metadata. A large focus was on NwHIN recommendations. Recommendations (.ppt) 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.”

New Initiative to Focus on New Primary Care Payment and Delivery Models The CMS Innovation Center announced a new initiative this week focused on strengthening primary care through a new service delivery and a new payment model. The Comprehensive Primary Care (CPC) initiative will foster collaboration between public and private payers to invest in primary care in five to seven selected localities across the country. The service delivery model will test comprehensive primary care, which is characterized as having the following five functions: (1) Risk-stratified Care Management; (2) Access and Continuity; (3) Planned Care for Chronic Conditions and Preventative Care; (4) Patient and Caregiver Engagement; (5) Coordination of Care Across the Medical Neighborhood.

The payment model includes a monthly care management fee paid to the selected primary care practices on behalf of their fee-for-service Medicare beneficiaries and, in years 2-4 of the initiative, the potential to share in any savings to the Medicare program. Practices will also receive compensation from other payers participating in the initiative, including private insurance companies and other health plans, which will allow them to integrate multi-payer funding streams to strengthen their capacity to implement practice-wide quality improvement.

Draft Spending Bill Would Rescind Nearly $7B for Health Reform Initiatives House Republicans released a draft spending bill (.pdf) Thursday that would cut off funding for many parts of the healthcare reform law. Though observers say the bill has little chance of moving forward as it remains deadlocked in the Appropriations Committee. According to the terms of the draft legislation, the bill would rescind $6.8 billion and it would block funding for the Affordable Care Act until legal challenges over the law’s individual coverage mandate have been settled. Of particular importance are potential cuts to the CMS Innovation Center totaling $1.8 billion. The Innovation Center is where Accountable Care Organizations, Bundled Payments and other payment reforms are being tested; the Center is also undertaking delivery reforms, such as readmission rate and preventable error reduction initiatives. While not directly tied to health IT funds, these initiatives portent a level of technology adoption that will rely on electronic health records and robust levels of exchange.