In a lively press briefing for members of the healthcare media assembled at the CHIME Fall Forum, the two Washington advocacy directors for the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) shared their perspectives on current issues and initiatives, on Oct. 15, during the CHIME Fall Forum, being held at the JW Marriot Grande Lakes Resort in Orlando, Florida.
Leslie Kriegstein, CHIME’s vice president, congressional affairs, and her colleague, Mari Rose Savicikis, who joined CHIME last month as vice president, federal affairs, offered healthcare journalists attending the CHIME Fall Forum their insights on what is going on in the U.S. Congress and in the Obama administration around issues related to healthcare IT policy, and shared the organization’s advocacy goals for the near future.
Kriegstein began the joint presentation by outlining CHIMEs top advocacy priorities in working with Congress and the Obama administration, as of the beginning of calendar year 2015. She said those priorities were, in descending order: patient identity matching, cybersecurity, meaningful use, patient safety, telemedicine, quality measurement, and ICD-10. Obviously, the ICD-10 issue has largely been resolved, with the fulfillment of the October 1 deadline for the transition to that new coding system in the U.S.; but the other issues continue to e very active for the association.
It has been an exceptionally busy and development-filled time lately on Capitol Hill and in the federal agencies when it comes to healthcare policy connected with IT and data Kriegstein noted. For one thing, the federal agencies engaging in activities and initiatives that touch on healthcare IT has been expanding beyond some of the ones historically involved, particularly the Department of Health and Human Services (HHS), and within HHS, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC). Recently, she noted, ““We have seen folks kind of take more ownership over the health IT space. So we’re seeing non-traditional players like Homeland Security and the FDA [Food and Drug Administration] become active. The CDC [Centers for Disease Control and Prevention], the Office of Civil Rights, the Office of Science Technology Policy,” are among the numerous federal agencies whose regulatory activity has touched on healthcare IT. In fact, she said, “We’re seeing an unprecedented level of interest. And that has set the stage perfectly for the CIO,” and has naturally compelled CHIME and its lobbyists forward in moving to advance CIO/healthcare IT leader interests.
Meanwhile, the events of October 6 were of particular note, and both Kriegstein and Savickis made a number of comments about them and answered questions from the press. With regard to the modifications for the Stage 2 final rule for meaningful use under the HITECH (Health Information Technology for Economic and Clinical Health) Act, Kriegstein stated that “That was a huge priority for us, to get that modifications of the rule out. We were very much appreciative that there were actionable modifications from the Administration on certain measures,” she said. “The fact that we will be less accountable for actions of patients, we welcomed with open arms; the fact that they included some restrictions around e-prescribing, we appreciated. We appreciate that the Administration is often responsive to members’ concerns,” she said, “but sometimes because a change comes so late that it may not always be able to realized by CIOs and eligible providers.”
On the other hand, the fact that the modifications to Stage 2 were published within the same rule as the release of the Stage 3 final rule was baffling to the CHIME team, Kriegstein said. “We were definitely surprised to see that the two rules were connected, the Stage 2 modifications, and Stage 3. That was disheartening,” she said, “and you saw the big push working with the Capitol Hill community. Some of us sent letters seeking to separate Stage 3 from the modifications rule.” Savickis then confirmed that the rule containing both had officially been published Wednesday in the Federal Register. Based on that, the effective date for the implementation of the rule published Wednesday will be in 60 days, according to federal law.
“Because the attestation window is after the effective date, you can go forward with what’s been proposed,” Kriegstein went on to say. “The wild card is the fact that it’s a final rule with comment. CHIME does plan to move forward with formal comment,” she added. “We may include some comments on the modifications piece,” she said.
In response to a question from Healthcare Informatics on whether the publication of a final rule with a request for comment might be unprecedented, Savickis said that interim physician fee schedules had in the past been published as final, with comments. “What’s uncommon is for the government to issue a fee schedule with two individual rules that have two different trajectories,” she said. “The timing, the sequencing, is very strange, and then to have them married up at the last minute,” is very unusual, she said. “And the only portion of the rule open for comment is Stage 3, and not the modifications portion.”
A number of questions remain regarding how everything around the combined rule will sort out, Kriegstein said. As for how federal healthcare officials might respond to any comments made by healthcare leaders related to the supposedly final Stage 3 rule, she said, “That’s unclear; and it’s unclear what will happen with the final certification rule. CMS and ONC have said they’d eventually like to see certification outside the MU program, but so much of it is connected to the MU program.”
“I think that we’re in strange times,” Savickis offered, noting that the two rules had originally gone to the Office of Management and the Budget “as two separate rules, but somehow got married.”
What’s more, Kriegstein said, referencing a recent public phone-in session, “Also, on the CMS call, we heard the uncertainty around MIPS [the new Merit-based Incentive Payment System created under the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) legislation, passed in Congress and signed by President Obama in April]. Stage 3 was developed in the pre-MIPS era, and the MIPS RFI is open for comment. So there’s uncertainty there, too. Will any of the changes in the Stage 3 “final-ish” rule, will those be included in MIPS?” she asked.
Instead of becoming overly focused on issues around the dovetailing of clinical measures that might be included under the MIPS system and needing to be harmonized with meaningful use Stage 3 measures, Kriegstein said, “We’ve told our members to focus right now on 2015. Just make sure you’re ready to go, but then keep in mind that 2016 is 365-day reporting period. We had hoped that they would recognize the value of a 90-day reporting period, but they didn’t for 2016, and you only can get it for 2017 if you’re an early Stage 3 adopter. So will be 365 days come January 1, 2016,” she reminded her listeners.
After the conclusion of the press briefing, CHIME’s advocacy directors spoke exclusively with Healthcare Informatics. Asked what CHIME’s core strategy will be going into the discourse and process around Stage 3 of meaningful use, Kriegstein told HCI, “We’re going to see the provider community going to Capitol Hill, and trying to revisit the letters, the public statements, so I anticipate the provider community being in lockstep, and that will be a powerful vehicle, and more than that, we’ll just try to get out there what the average CIO is experiencing, and the realistic capabilities they’ll need to be in compliance with Stage 3. The fact that the average hospital isn’t able to incorporate patient-generated data, and we’re very reliant on FHIR [the Fast Healthcare Interoperability Resources Specification], which is a draft standard. We have to be realistic in implementing all the great ideas out there.”
Added Savickis, “And we need to take away some of the pressure from vendors, in terms of way-too-detailed requirements on them. That’s not solved by meaningful use or certification. I’ve heard a term from a major vendor, ‘meaningful use hangover.’ That kind of comment gives you pause.”
Looking Beyond MU towards Other Paths to Interoperability
In addition to covering the latest developments around the meaningful use process, the CHIME lobbyists noted a number of bills that have been introduced into the U.S. Congress or may very soon be introduced into it. In that regard, Kriegstein said, “I think we will see something come out of the HELP Committee”—the U.S. Senate Committee on Health, Education, Labor & Pensions. “With Sen. [Lamar] Alexander [R-TN] being involved—I think we’ll see some results. CHIME first met with a bipartisan workgroup in the HELP Committee last July,” she noted.
“What are CIOs saying about interoperability?” Kriegstein asked. “First and foremost, we need to be able to identify patients. No, we can’t use a SS number and no, we don’t have a national patient identifier. That’s always going to be at the top of the list for CIOs. And we’re hearing them say that meaningful use is almost a distraction from all of this. What they want now is an integrated, learning health system to transform healthcare. And CIOs are investing so much of their time, energy, and money, that there’s not the ability to move things forward.”
Meanwhile, Savickis said, “When the Administration says 60 percent of the measures are focused on interoperability, in fact, interoperability is lacking in some of these measures in meaningful use. So it’s a little challenging. We want to be solution-oriented, which is why we’re really trying to insert ourselves around patient identification and data security. There’s a bit of a disconnect in the Administration around that.”
“And we’ll achieve interoperability by keeping as many providers and hospitals in the program,” Savickis said, referring to the meaningful use program. “There was definitely value in the program spurring adoption. The program has been a success in terms of adoption.” But, she said, it’s time for “the vendors to innovate, rather than having to develop for the government’s needs, instead of the providers.”
“And the last piece that CHIME has been very focused on,” Kriegstein added, “is a consistent set of measures around capture and exchange. That’s a huge change. That’s why we’ve been supportive of the ONC Interoperability Standards Advisory. We’d like to see one set of standards to achieve interoperability.” And both Kriegstein and Savickis reiterated CHIME’s intensive focus on patient identification as a cornerstone of true interoperability, U.S. healthcare system-wide.