Washington Debrief: Meaningful Use Adjustments Included in Republican Healthcare Reform Agenda

Congressional Affairs

Meaningful Use Reforms Included in Republican Obamacare Replacement Outline

Key Takeaway: House Republicans, led by Speaker Paul Ryan (R-WI-01) released a white paper outlining their healthcare reform agenda last week, which included references to reforming the Meaningful Use program and transparency in the regulation of mobile medical applications.

Why It Matters: In the six years following the passage of the Patient Protection and Affordable Care Act (PPACA), Congressional Republicans have discussed their interest in repealing and replacing the legislation passed in 2010. The proposal unveiled this week offered insight into the principles they hope to include in their legislative package.

The proposal cites an interest in policies to spur innovation and break down legal and regulatory barriers to advance the use of electronic health records. Interest in adjustments to the Meaningful Use program would be focused on interoperability and data exchange.

The proposal calls for creation of a figurative health care “backpack”, which would include one’s insurance as well as a portable medical record that can be transported by the patient. CHIME supports the development of longitudinal healthcare records, but will continue to work with Congress and the Administration to outline the existing policy and technical barriers that prohibit the creation of such records today. The health care “backpack” discussed in the proposal will only be possible when a patient can be correctly and consistently linked to their healthcare data, and when a clear set of enforceable data standards are in place to facilitate data exchange.

While we await the specific legislative text of the proposal outlined by Speaker Ryan last week, CHIME is encouraged that there is interest in reorienting the Meaningful Use program toward interoperability and outcomes. We look forward to reviewing the specifics when they are released and will continue to advocate for bipartisan, sensible, reasonable policies that enable health IT tools to be valued resources for patients and clinicians alike.

House Bill Would Extend MU Incentive Payments to Long-Term and Home Health Communities

Key Takeaway: As part of a legislative package to reduce health disparities, Meaningful Use program eligibility would be extended to long-term care centers, home health providers and physician assistants.

Why It Matters: The proposal introduced into the House earlier this month, would expand eligibility under the Meaningful Use program and directs the Department of Health and Human Services (HHS) to study the use of health information technology in medically underserved communities.

The Health Equity and Accountability Act of 2016 (H.R. 5475), was introduced by Representative Robin Kelly (D-IL-02), and has 17 cosponsors.

VA Officials Tell Congress Department is Moving Ahead with a Commercial EHR System

Key Takeaway: In testimony before the Senate Committee on Veterans Affairs, officials from the Department of Veterans Affairs (VA) told lawmakers that Veterans Health Information Systems and Technology Architecture (VistA) is outdated and they are likely moving ahead with a commercial electronic health record (EHR) system.

Why It Matters: Lawmakers have expressed concern with the lack of interoperability between the EHRs of the Department of Defense and the VA, and have criticized the amount of money spent over the years to improve their legacy systems.

During the hearing entitled, “Examining the Progress and Challenges in Modernizing Information Technology at the Department of Veterans Affairs,” the committee heard testimony from Under Secretary of Health, Department of Veterans Affairs, Dr. David Shulkin, who was accompanied by other VA officials including the CIO, Laverne Council.

The Commission on Care proposal cites serious flaws in the existing VA electronic medical record systems, including difficulty communicating with major commercial vendors. Appoint scheduling, billing, coding and payment were areas of weakness for the VA health IT systems today.

VistA will continue to be used by the VA at least through 2018, when the agency starts creating a cloud-based Digital Health Platform that may include some VistA elements, with the hope of leveraging the HL7 FHIR standard.

Federal Affairs

CMS proposed rule for hospitals has IT components including changes to Conditions of Participation

Key Takeaway: New CMS proposed rule takes aim at patient access to medical records and CEHRT

Why it Matters: On June 16^th CMS published a proposed rule that updates the requirements that hospitals and critical access hospitals (CAHs) must meet to participate in the Medicare and Medicaid programs. Two pieces in particular may be of interest to CIOs. One would be required for meeting Medicare’s Conditions of Participation (COP).

Patient Access

CMS explains that previously adopted rules which make clear that hospitals must provide patients with access to their medical records did not take into account electronic access. The rule aims to clarify access to electronic records and accessing them electronically are patient rights. They state they have this right when made:

upon an oral or written request, in the form and format requested by the individual, if it is readily producible in such form and format (including in an electronic form or format when such medical records are maintained electronically); or, if not, in a readable hard copy form or such other form and format as agreed to by the facility and the individual, within a reasonable time frame.

They remind hospitals that patients who are not given their medical records upon request within the 30 days required by HIPAA can file a complaint to OCR.

These changes would be part of a hospital’s Medicare COP.

CEHRT

In discussion about hospital Quality Assessment and Performance Improvement (QAPI) requirements, CMS notes that while they are not proposing to require that hospitals develop and implement information technology (IT) systems as part of their QAPI program, they are encouraging hospitals to use IT systems, including systems to exchange health information with other providers, that are designed to improve patient safety and quality of care. They add they think those facilities that are electronically capturing information should be doing so using certified health IT (CEHRT) because this will, “enable real time electronic exchange with other providers. By using certified health IT, facilities can ensure that they are transmitting interoperable data that can be used by other settings, supporting a more robust care coordination and higher quality of care for patients.”

CMS Enterprise Portal Access Deadline

Key Takeaway: CMS requires those accessing the CMS Enterprise Portal to recertify their accounts

Why it Matters: The deadline to recertify access to CMS’ Enterprise Portal by June 30^th. Enterprise Identity Management (EIDM) security officials (SOs) and individual practitioners must recertify their user accounts by this date. In July 2015, CMS transitioned from the Individuals Authorized Access to CMS Computer Services (IACS) system to the EIDM system. Since EIDM users must recertify their accounts annually, the deadline is right around the corner.

The SO and Individual Practitioner can recertify by logging into the CMS Enterprise Portal using existing EIDM credentials to access the list of users who require recertification. SOs and individual practitioners can locate the list of users by navigating to the View and Manage My Access page after logging in and selecting the Annual Certification link on the left pane. The SO and Individual Practitioner can recertify multiple users at one time. If you experience issues trying to recertify users, users should call the QualityNet Help Desk immediately at 1-866-288-8912. The QualityNet Help Desk hours of operations are Monday - Friday, 7 a.m. to 7 p.m., central time.

Telehealth Update

Key Takeaway: MedPAC issues report to Congress that includes telehealth recommendations

Why it Matters: The drumbeat to push Medicare to expand its coverage policy on telehealth services continues in Washington. MedPAC, the body that makes recommendations to Congress on Medicare payment issues, released a 347-page report which includes recommendations around payment for telehealth services. The topic is discussed in chapter eight starting on page 249.

They call the evidence around telehealth mixed noting evidence that it improves access is stronger than evidence that it saves money or improves quality though there is some evidence of this with the chronically ill populations. The Commission says that if Medicare is to expand telehealth services they should need to differentiate between how this happens in traditional FFS vs Medicare Advantage and other models of care where the provider incurs the risk.

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