Washington Debrief: Pressure Mounts on Administration Surrounding MU

Oct. 5, 2015
CMS, despite not yet finalizing the so-called modifications rule that proposes several changes to the current stages of the meaningful use program, has closed its portal to attest to meaningful use for 2015 until January.

Federal Affairs

Meaningful Use Attestation in 2015

Key Takeaway:  The Centers for Medicare & Medicaid Services’ (CMS) portal to attest to meaningful use for 2015 is closed until January 4, 2016.

Why it Matters: CMS has not yet finalized the so-called modifications rule that proposes several changes to the current stages of the meaningful use program.  Importantly, the proposal called for a shorter, 90-day reporting period, as opposed to 365-days, and moving the deadlines for attesting for 2015 until no earlier than January 4, 2016.

In spite of the rule not yet being finalized—though publication is expected any day now—CMS did confirm with CHIME staff last week their intention to move the 2015 attestation period to early January. However, many stakeholders were either unaware of the change or had anticipated that the final rule was needed in order to make the change. Providers visiting the website will find an alert noting the system is undergoing maintenance and an alert that says:

EHR Program Announcement—The Attestation System will open on January 4, 2016 for Eligible Professionals, Eligible Hospitals, and Critical Access Hospitals to attest for Medicare Electronic Health Record Incentive Program for Program Year 2015.

CHIME has pointed out to CMS that providers feel hamstrung by their inability to attest in 2015 and that many providers’ balance sheets were counting on incentives, which are critical to provider budgets and are needed to continue making ongoing investments in infrastructure and patient care.

Leslie Kriegstein

GAO Reports Tackle Interoperability & Quality

Key Takeaway: A recent Government Accountability Office (GAO) report analyzed interoperability efforts currently underway in both the private and public sectors In “Electronic Health Records: Nonfederal Efforts to Help Achieve Health Information,” GAO, the government’s auditing arm,  not only noted that there are several efforts underway, but that significant barriers remain to achieving true interoperability.

Why It Matters: The topic of interoperability is not only being hammered out on the front lines of healthcare, the topic is under the microscope of policymakers who are scrutinizing how to further advance the needle forward and what barriers still exist. The Office of the National Coordinator for Health IT (ONC) has been tasked with “solving” this problem which they recognize will take both public and private sector solutions. 

Most interviewed for the report, who have initiatives underway, noted that their products and services would be more widely available within two years. As Washington policymakers— including those on the Hill—study this issue, pressure is increasing to ensure the promise of health IT to help providers deliver better care in a more efficient way and that the HITECH funding was well spent. Those interviewed by the GAO noted five areas that present challenges to realizing interoperability:

(1) insufficiencies in health data standards,

(2) variation in state privacy rules,

(3) accurately matching patients’ health records,

(4) costs associated with interoperability, and

(5) the need for governance and trust among entities, such as agreements to facilitate the sharing of information among all participants in an initiative.

Thirteen of the eighteen organizations interviewed by the GAO described work involving patient identification. CHIME has been blazing a trail forward on identifying a solution for a unique patient identifier through its National Patient ID Challenge.  As a recognized leader representing those on the front lines grappling with interoperability challenges, GAO sought CHIME’s perspective for this report. The U.S. Department of Health & Human Services (HHS) is prohibited under current law from implementing a national patient identifier until legislation is specifically enacted to approve a standard. Still, there is growing momentum in the private sector to find a unique patient identification solution. CHIME’s Hero X initiative is a great example of the private sector taking the lead on a complex issue. CHIME will nonetheless continue our advocacy with public policy makers on the need to remove this prohibition so that widespread adoption can occur across the entire healthcare system.

In a separate GAO report on quality, “Hospital Value-Based Purchasing,” auditors concluded that initial results show a modest effect on Medicare payments and no change in quality of care, though quality trends could emerge in the future as the value-based care initiatives continues to evolve. The one exception was readmissions, where a clear shift in trend towards improvement was found. GAO found a variety of factors contributed to hospitals’ ability to make quality improvements. A chief concern was EHR implementation. Hospitals reported “how implementing a new IT system slowed down their work as staff grappled with learning the system, how limitations to the system prevented the production of desired performance-related data, and how the IT system diverted significant hospital resources into implementing and maintaining the system — resources that could otherwise have been applied elsewhere, such as to quality improvement efforts.” Some hospitals, however, found EHRs helpful with improving quality.

CMS Release RFI on Merit-Based Incentive Payment System

Key Takeaway: The Centers for Medicare & Medicaid Services released a Request for Information (RFI) pertaining to forthcoming Merit-based Incentive Payment System and Alternative Payment Models (APMs). The new payment models were included in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which repealed the Medicare sustainable growth rate (SGR) for physician reimbursement.

Why It Matters: Included among the 127 questions in the RFI are inquiries about ways to change the meaningful use program and certification process in order to make them consistent with the physician reimbursement models that take hold in 2019.

MACRA set participation in the meaningful use program as one of the four performance categories for the MIPS program. The RFI requests stakeholder feedback on how to account for a physician’s participation in meaningful use such as,” Should the performance score for this category be based be based solely on full achievement of Meaningful Use?” The questions hint at the potential for a rethinking of the current “all-or-nothing” construct of the Meaningful Use Program. Other notable questions include:

  • Should CMS use a tiered methodology for determining levels of achievement in this performance category that would allow EPs to receive a higher or lower score based on their performance relative to the thresholds established in the Medicare EHR Incentive program’s meaningful use objectives and measures?
  • What are the core health IT functions that providers need to manage patient populations, coordinate care, engage patients and monitor and report quality? Would certification of additional functions or interoperability requirements in health IT products (for example, referral management or population health management functions) help providers succeed within APMs?’
  • Instead of requiring that the EHR be utilized to transmit the [quality] data, should it be sufficient to use the EHR to capture and/or calculate the quality data? What standards should apply for data capture and transmission?

Congressional Affairs

Last Senate Hearing Features Pleas for MU Mod Rule Release, Discussions of Patient Identification

Key Takeaway: In the sixth and final hearing on health IT held by the Senate Health, Education, Labor and Pensions (HELP) Committee, senators offered their interpretations of the range of interoperability impediments.

Why It Matters: Congress has taken notice that more than $30 billion has been spent to incentivize the adoption and use of EHRs through the Meaningful Use program, yet clinicians and patients alike recognize the current status of health IT use is subpar and often a source of frustration. The series of hearings, is the most dramatic instance of congressional interest in health IT since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009.

The final hearing featured Acting Assistant Secretary of Health and ONC chiefKaren DeSalvo, M.D., and, and Patrick Conway, M.D., deputy administrator for innovation & quality and chief medical officer, CMS.

Committee chair, Sen. Lamar Alexander (R-TN) reiterated his call for the administration to immediately release the meaningful use modifications rule governing the program for 2015 and to withhold from final rulemaking pertaining to Meaningful Use Stage 3 until 2017. Earlier in the week, Alexander joined Sen. John Thune (R-SD), chairman of the Senate Commerce, Science and Transportation Committee, to pen a letter to HHS Secretary Sylvia Burwell with the same request.

Alexander said that getting the Stage 3 regulations right was more important than rushing them through the regulatory framework, noting that several payment rules have been finalized since the initial proposal for Stage 3. He also cautioned that Congress could take legislative action to address the issue, something he said he would like to avoid.

The hearings allowed committee members to voice their ideas to foster true interoperability and to encourage health data exchange. One of the topics that was discussed in a bipartisan fashion was the issue of patient identification. Sen. Elizabeth Warren (D-MA) referenced a 2012 CHIME study outlining the adverse events CIOs could trace to patient mismatches. Sen. Bill Cassidy (R-LA), a physician, cited a patient identifier as a critical component of data sharing, suggesting a voluntary program like the U.S. Customs and Border Patrol’s Global Entry program.

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