CMS’s Slavitt and ONC’s DeSalvo Offer Clarity on Federal Healthcare IT Policy

April 16, 2015
In prepared remarks and responses to proffered questions at the final keynote session at HIMSS15 in Chicago, Andy Slavitt of CMS and Karen DeSalvo, M.D., of ONC, made starkly clear what they expect of providers going forward—as well as of their own federal agencies

Two of the top federal officials with responsibility for healthcare IT policy clarified on Thursday, April 16 at HIMSS15 their vision for the future not only of healthcare IT, but of healthcare delivery and payment, for healthcare IT leaders gathered on the last day of the annual HIMSS Conference, at Chicago’s McCormick Place Convention Center.

Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), and Karen DeSalvo, M.D., National Coordinator for Health IT, spoke to about 4,000 HIMSS attendees gathered in the Skyline Ballroom at McCormick Place, and offered a unified vision of transformational change in healthcare facilitated by healthcare IT.

At a keynote session that lasted over an hour and 15 minutes and that saw addresses by DeSalvo and then Slavitt, the statements each gave near the conclusion of the session encapsulated their widely ranging comments. The chair-elect of the board of HIMSS (the Chicago-based Healthcare Information & Management Systems Society, sponsor of HIMSS15), Dana Alexander, asked each if they had a concluding message they would like to leave with the healthcare IT leaders gathered in the ballroom.

Karen DeSalvo, M.D., Andy Slavitt, and Dana Alexander at HIMSS15

Slavitt said, “We are moving to a place where it’s not about adoption of technology, but where, when you are walking the halls of a clinic, are patients feeling the improvement, and are caregivers feeling the improved productivity? The good news is that we have momentum, but I fear that if we don’t get very urgent about it, it won’t move fast enough.” That’s why, he said, it was important for all the federal healthcare agencies to continue to push the healthcare industry forward not only to adopt health IT, but also to collaborate to change the U.S. healthcare delivery system.

And DeSalvo responded by saying, “It’s the fourth quarter, and games are won and lost in the fourth quarter. We have a plan, and we’re executing on the plan, and we know we can’t do it alone. But the change in payment models and continued progress will have to continue in the private sector and in the states,” she said. “That’s one of the reasons we’ve set goals out to 2018… to give some stability and certainty to the future. It’s really important to us and the administration, that we are partnering, collaborating, consulting, and listening,” to and with healthcare providers going forward.

Opening the keynote session, DeSalvo delivered her prepared remarks first, saying that healthcare IT adoption “has brought us all to a tipping point. Today, we know that adoption is strong. Such incredible accomplishments from just five years ago—these are the result of your hard work; and I know it is hard work,” she said, addressing the healthcare IT leaders in the audience. She added that “increasing changes to health information exchange and interpretability are just beginning,” and that “We have much work to do to achieve true interoperability, not just exchange.” She made it clear that the Office of the National Coordinator for Health IT (ONC) was, while continuing to ensure that the meaningful use program under the HITECH (Health Information Technology for Economic and Clinical health) Act evolved forward successfully, already looking far beyond the conclusion of that program towards a future of collaboration with healthcare provider leaders.

In his prepared remarks, Slavitt offered his listeners a clear, rigorous vision of the aims of CMS and of the federal healthcare agencies in relation to the provider sector in healthcare.  “Our priority is simple: to drive a delivery system that provides better care, smarter spending, and keeps people healthier,” he said. “The success in the first five years since the Affordable Care Act has been very encouraging. We’ve moved lack of insurance from 20 percent to less than 13 percent. We’ve reduced patient harm in the last four years in hospitals by 17 percent. And we’re not doing this by breaking the bank. Health inflation is at its lowest rate of increase in four years. Our agenda now,” he said, “is to get busy strengthening these gains. That will mean that more providers in more communities will need to be able to transform the care they provide so that they will benefit from value-based reimbursement. And they will need technology to help them get there.”

Slavitt cited three key goals he wanted CMS to help providers accomplish in the coming years. “One, care providers and patients should begin to feel the benefit from all that investment in care technology, what I call the care dividend,” he said. “Second,” he said, “we have a great need for a more modern infrastructure in healthcare. For the healthcare industry to become truly as great as we deserve… we need a Moore’s law effect in healthcare productivity to care for our dual-eligible patients and aging Baby Boomers, and we need technology to do that. I think we could do with a little less emphasis on shareable and wearable and more infrastructure emphasis.” In that regard, he cited new grants coming out of CMS for technology investments by state Medicaid programs. With regard to what Medicaid programs and other initiatives need, he said, “We need off-the-shelf, easy-to-maintain, modular systems that are faster to stand up and use.”

Meanwhile, citing the third key goal he foresees, Slavitt said, “The final area is the area where I have the greatest concerns: interoperability. I visited an FQHC [federally qualified health center] yesterday morning; they’ve got a great EHR [electronic health record] and analytics capability, and some of the highest quality results in the country, only their physicians can’t follow patients across the continuum” through a longitudinal record. In the coming years, he said, “This will not be acceptable to patients, will not be acceptable to providers, will not be acceptable to taxpayers, and will not be acceptable to us.” In short, he said, “I’m asking a great deal more of innovation in our system. It’s time to get to business and advance the gains that have really begun.”

Slavitt added that, for the agency’s part, “We need to continue to get better at listening, adapting, and becoming a more solution-oriented partner. As you implement, we need to adjust and make things easier for you. Second, we need to be more clear on our goals and expectations. In January, we announced goal that 30 percent of Medicare fee-for-service payments should be tied to models around quality and value by 2016 and 50 percent by 2018.” Healthcare IT, he underscored, will be essential to helping facilitate transformational change among providers.

He added that “We’re trying to change the payment model, encourage interoperability, everything… We have such a great, bold agenda. That’s half of my focus. The other half of my focus is on, what are the cultural things we need to do at CMS to implement programs to be better partners? There is an incredible workforce at CMS that is very excited about delivering this change,” he said. And, as far as healthcare IT adoption is concerned, he added, “I think we know what we need to do.” What will be important going forward, he said, is to execute on the promise of healthcare IT.

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