Washington Debrief: Hospital Data Exchange Rates Increasing, Says ONC

Health IT Policy Update – April 20, 2015

Federal Affairs

90-Day Reporting Period, Changes to VDT Requirement Included in MU Modifications Proposed Rule

Key Takeaway: A Centers for Medicare and Medicaid Services’ (CMS) proposed rule was published in the Federal Register last week. The rule would shorten the EHR reporting period in 2015 to 90 days and loosen requirements for patient access to electronic health information, among other program modifications.

Why It Matters: Health IT executives should plan to report for any continuous 90-day period in 2015 from Oct.1, 2014 through Dec. 31, 2015, in keeping with CMS’ intention to move hospitals to a calendar year reporting period. Executives should also study the rule for a host of changes proposed to Stage 2 that will likely impact clinical workflows.

A CMS rule published last week would give providers an additional quarter to attest to meaningful use (MU) in 2015, by moving eligible hospitals (EHs) and critical access hospitals (CAHs) to calendar year reporting periods; it would allow providers to report over any continuous 90 day period in 2015; and it would change a handful of measures and objectives in preparation for Stage 3 requirements scheduled to begin in 2017. Other notable provisions include:

• Patient Electronic Access measure - 5 percent threshold for ‘View, Download and Transmit’ adjusted to “equal to or greater than one patient.”  
• Secure Electronic Messaging measure (for Eligible Providers) – previously a threshold measure, changed to yes/no measure stating if the functionality is fully enabled. 
• Public Health Reporting measures – consolidated to align with the proposed Stage 3 rule, providers must report on 2 of 5, and 3 of 6 for hospitals.
• Eliminates reporting of measures considered “topped out” or redundant, but in the process also makes all optional (called “menu”) requirements mandatory.
  • For stage 1 attesters, this makes medication reconciliation, patient education, and public health reporting required.
  • For stage 2 attesters, this moves e-prescribing from an optional measure to mandatory.  
• In 2015, CQMs can continue to be reported either electronically or through attestation for any 90-day period.
• In 2016 and after, CQM data can be reported either electronically or through attestation, but must cover the entire calendar year. 

The proposed rule has a 60-day comment period that closes on June 15, 2015. CMS announced their intentions to finalize this rule by mid-August 2015.

CHIME and AMDIS will submit comments on this proposed rule. To share you initial thoughts on the proposed program modifications please contact the CHIME Public Policy team.

ONC Releases Revised Guide on Privacy and Security of Electronic Health Information

Key Takeaway: Last week the Office of the National Coordinator for Health IT (ONC) published an updated guide on how providers and IT professionals can manage the privacy and security of electronic health records.

Why It Matters: Health IT executives should look to ONC’s guide for best practices and step-wise advice to update privacy and security practices surrounding electronic health information. The guide serves as an update to a 2011 edition, but is intended to bring new, practical information about privacy and security to small provider settings.

The guide includes seven steps providers should take to implement a security management process, a requirement under the Health Insurance Portability and Accountability Act (HIPAA) Security Rule that is defined as implementing policies and procedures to identify and prevent data security risks.

The guide includes definitions for a patient's right to access health information; what a security breach is; and what providers must do to inform patients when a breach occurs.

Hospital Data Exchange Rates Increasing says ONC

Key Takeaway: The percentage of hospitals electronically exchanging health information with health-care providers outside their IT network has steadily increased since the establishment of the federal State Health Information Exchange Program, according to a data brief released by the ONC last week.

Why it Matters: According to the ONC brief, as of 2014, 76 percent of all hospitals had exchanged some clinical data with another healthcare provider or hospital. The data indicates that an increasing amount of providers are exchanging information with partners outside their own organization, which is a pre-requisite step towards interoperability.

The ONC brief noted that the percentage of hospitals exchanging data varied slightly between 2008 and 2010, growing from 41 percent to 45 percent between 2008 and 2009 then falling back to 44 percent in 2010. However, the percentage of hospitals exchanging data increased steadily after 2010, when the ONC's State HIE Program was initiated.

Although the brief stated that data exchange has grown rapidly, the findings neglect to assess the volume, quality and availability of the data exchanged at the point of care.

In a separate report, CMS data found that over 9-in-10 hospitals eligible for the Medicare and Medicaid EHR Incentive Program have achieved the Meaningful Use of certified health IT. The February data shows that 86 percent of eligible hospitals have now been paid through the Medicare EHR Incentive Program. This percentage equates to the highest participation rate on record for the program.

Stage 1 attestations by hospital classification based on CMS data:

• 96% of large hospitals
• 92% of medium hospitals
• 93% of small rural hospitals
• 78% of small urban hospitals
• 90% of critical access hospitals
• 57% of children's hospitals

FTC Responds to ONC Interoperability Roadmap

Key Takeaway: Among the list of respondents to ONC’s Interoperability Roadmap was the Federal Trade Commission, outlining how competition can foster interoperability.

Why It Matters: Health IT executives should view the FTC’s continued interest in health IT and interoperability to be indicative of the Commission’s interest in maintaining a competitive environment to benefit providers and vendors alike.

The FTC’s response called on ONC to study how vendors and providers have intentionally slowed interoperability, as a method to lock-in customers. Further, the FTC suggests ONC refocus initiatives and payment models to require healthcare providers to willfully share information.

ONC’s emphasis on aligning standards was of concern to the FTC, citing unintended consequences such as harnessing innovation and competition by excluding new products or competitors from the standards setting or certification process. The FTC advised ONC to carefully monitor the standards setting process.

Congressional Affairs

ONC Reports to Congress on Extent of Information Blocking Practices

Key Takeaway: Last week ONC submitted a report outlining reality information blocking among providers and technology vendors, fulfilling a Congressional request from the government funding package that became law in late 2014.

Why It Matters: This report is likely the beginning of an ongoing focus on information blocking practices by federal policymakers and Congressional lawmakers. For example, information blocking language was included in the Medicare Sustainable Growth Rate (SGR) reform package that passed the House last month.

The report cites the limited availability of data, but still suggests there is little doubt that information blocking is occurring and that it is impeding electronic exchange of health data. While the report is absent references to any particular EHR vendor or provider organization, it mentions the fees associated with sending, receiving or soliciting patient information and to the interfaces needed to allow data sharing across care settings.

The report provides criteria for identifying information blocking from other barriers to interoperability, and describes current and proposed actions. ONC outlines ongoing and planned actions to remedy information blocking across the industry.

A notable finding of the report is that many types of information blocking are beyond the reach of current federal law address according to ONC.  ONC says instead, that a comprehensive approach will require overcoming significant gaps in current knowledge, programs, and authorities that limit the ability of ONC and other federal agencies.

Permanent Fix for Medicare’s Sustainable Growth Rate Becomes Law

Key Takeaway: Doctors will no longer face looming Medicare reimbursement cuts upwards of 20 percent, as the Medicare Access and CHIP Reauthorization Act of 2015 became law last week, repealing the broken reimbursement formula and launching the transition of the nation’s Medicare providers toward a value-based payment model before 2019.

Why It Matters: Under the new law, a physician’s participation in Meaningful Use Program becomes one element of a physician’s bonus under the Merit-based Incentive Program System or MIPS. Penalties for eligible physicians will sunset in 2019, but the penalties are set to continue in perpetuity for eligible hospitals.

Three previous incentive programs will be combined into MIPS, the value-based payment program that assesses the performance of each eligible provider based on quality, resource use, clinical practice improvement activities, and meaningful use of certified electronic health record technology.

The law’ includes an "interoperability mandate" which will require EHRs to be interoperable by 2019 and instructs HHS to develop performance metrics around interoperability.