Washington Debrief: House Passes 21st Century Cures Act, Includes Interoperability, Patient ID Provisions

July 13, 2015
On Friday, the House passed the 21st Century Cures Act (HR 6), which in addition to increase NIH funding by $8.5 billion, included a number of EHR and health information exchange directives.

Congressional Affairs

House Passes 21st Century Cures Act, includes Interoperability, Patient ID Provisions

Key Takeaway: On Friday, the House passed the 21st Century Cures Act (HR 6), which in addition to increase NIH funding by $8.5 billion, included a number of EHR and health information exchange directives.

Why It Matters: The legislation, designed to help spur medical innovations, included language to deter information blocking and increase incentives for standards identification as a means to foster interoperability.

According to the bill passed by the House last week, with respect to all electronically accessible health information, health information technology systems must: allow for secure transfer of such information to and from other systems; allow for complete access to, exchange, and use of such information; and not information block. Information blocking is defined to include any technical, business, or organizational practices that an actor knows, or should know, prevents or materially discourages access to, exchange, or use of health information.

The legislation sets forth six categories of standards that are required for interoperability, which include: (1) vocabulary and terminology; (2) content and structure; (3) transport of information; (4) security; (5) service; and (6) querying and requesting health information for access, exchange, and use. Further, the House made $10 million available for contracts with American National Standards Institute (ANSI) accredited Standards Development Organizations to identify or develop standards in the six identified categories.

The legislation mandates compliance with interoperability criteria and standards is required for: vendors of health information technology offered for use by a provider participating in Medicare or Medicaid; health information systems (including health information exchanges); hospitals; and healthcare providers. electronic health record (EHR) systems may be found out of compliance, then decertified. In the case of decertified products, providers will receive a minimum of one-year hardship exemption from participation the Meaningful Use Program.

Additional disclosures are to be made by EHR vendors under the House bill, including pricing information, Application Programming Interfaces (APIs), and real-world test results among others.

CHIME applauded the language signifying the importance of ensuring the information in a patient’s record belong to that patient for care coordination and patient safety purposes. This language was viewed as an important next step in launching a national dialogue on need for a universal approach to patient identification.

“an individual should have the right to be confident that the data in the electronic health record of the individual pertains to such individual;

and the right described [above] will promote safety and care coordination for individuals.”

Prior to the bill’s passage, Representative Steve King (R-IA-04) introduced an amendment to eliminate Meaningful Use penalties for eligible provider’s dating back to January 1, 2015, while offering rebates to penalized physicians. The amendment was not include for consideration by the full House, but signals a continued interest among lawmakers to reform the Meaningful Use Program.

The Senate has begun a similar initiative, Innovation for Healthier Americans, which could also include health IT-related provisions resulting from the ongoing series of hearings hosted by the Committee on Health, Education, Labor and Pensions (HELP). HELP Committee Chairman Lamar Alexander (R-TN) announced his intention to have legislation for the Senate to consider early in 2016.


CHIME Submits Comments to Senate HELP Health IT Working Group

Key Takeaway: CHIME submitted recommendations to the Senate Health, Education, Labor and Pensions Committee following Chairman Lamar Alexander’s (R-TN) request for 5-6 solutions to “fix” EHRs and health IT.

Why It Matters: CHIME offered solutions that could result in tangible improvements in how providers employ health information technology to deliver better care to patients. CHIME made recommendations concerning patient identification, quality measurement, standards identification, certification, patient engagement and Meaningful Use.

CHIME pointed to the lack of a consistent patient identity matching strategy as the most significant challenge inhibiting the safe and secure electronic exchange of health information, calling for the removal of the prohibition barring federal regulators from identifying standards to improve positive patient identification.

“Foundational to the vision espoused by the Committee to improve information exchange and improve patient care, is the ability of providers to accurately and consistently match patients with their data,” CHIME stated.  “With the removal of the outdated prohibition, we believe then that the nation can sincerely engage in a dialogue on finding solutions to solve this fundamental patient safety problem.”

Citing the growth of value-based reimbursement, CHIME called on the HELP Committee to prioritize a unified strategy for capturing and communicating quality in healthcare. Additionally, CHIME called on the Committee to support the federal government as the entity to incentivize the use of standards in priority areas to ensure providers are capturing and exchanging data in the same fashion. CHIME’s recommendations suggested that a more defined technical infrastructure is needed to catalyze innovations in digital health.

Healthcare CIOs expressed the need to reorient ONC’s Certification Program with a renewed focused on interoperability in the following ways:

  1. Require changes to ONC’s approach to testing;
  2. Enhance ONC’s ability to enforce adherence to certification program requirements;
  3. Establish mechanisms to bring more transparency to the performance of Certified EHR Technology (CEHRT) especially related to interoperability.

CHIME closed their comments with recommendations to preserve the integrity of the EHR incentive program, and ultimately enabling this innovative program to deliver the return on investment to the federal government and to our tax payers.

Federal Affairs

CMS Announces Leniency in ICD-10 Coding Enforcement

Key Takeaway: Last week, the Centers for Medicare & Medicaid Services (CMS) announced additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD-10 code set.

Why It Matters: With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, last week CMS and the American Medical Association (AMA) are announced efforts to continue to help physicians get ready ahead of the October 1 deadline.

According to CMS’ guidance:

“While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.”

The CMS FAQ is available here.

While the CMS announcement received support from most former skeptics on Capitol Hill, Representatives Marsha Blackburn (T-RN-08) and Tom Price (R-GA-xx) introduced a bill last week require CMS to accept both ICD-9 and ICD-10 claims for 180 days after the October 1st transition deadline. CMS has stated that they are not technologically able to accept dual-coded claims.

The result of the June 1-5 ICD-10 end-to-end testing results were also released last week, according to CMS, a total of 90% of claims submitted by over 1,200 volunteers were accepted by the CMS. An analysis found most of the rejected claims were due to errors not related to ICD-10 coding.

First- Time EH Attesters Can Attest Between Now and August 14

Key Takeaway: The Centers for Medicare & Medicaid Services (CMS) has announced that the agency will allow hospitals participating in the electronic health record (EHR) Meaningful Use Program for the first time in 2015 to attest between now and August 14.

Why It Matters: The allowance of Meaningful Use attestations represents a reversal of CMS’ previously stated intention to require these hospitals to wait until January 1, 2016 to attest due to system changes being made by the agency.

Eligible hospitals and critical access hospitals (CAHs) participating in Meaningful Use for the first time this year may attest to a 90-day reporting period for fiscal year 2015. Under a temporary solution that will be implemented on a case-by-case basis, CMS will accommodate these hospitals as follows:

  1. The hospital must first register in the CMS Registration and Attestation System at: https://ehrincentives.cms.gov/hitech/login.action.
  2. Once the registration is active, the hospital should contact Elizabeth Holland in the Division of Health Information Technology at CMS ([email protected]) and provide the hospital name, CMS Certification Number and contact person information.
  3. CMS will then assign an individual to work with the hospital to complete its attestation.

Hospitals using this option must attest to the Stage 1 Meaningful Use requirements that were applicable beginning in 2014, not to the based on modifications to meaningful use for 2015 to 2017 proposed rule released last April. This option is available only to hospitals new to the program in 2015. Furthermore, hospitals using this option will not be able to attest again until January 2017 for a full-year EHR reporting period in 2016.

Eligible hospitals and CAHs that previously participated in the program must report on a full year of performance and will not be able to submit their attestations through the CMS Registration and Attestation System until the regular attestation is available in early 2016.

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