At a time of political, policy and industry transition, it can be difficult to get a bead on exactly how new developments and current trends will all play out. Certainly, discussions at the annual HIMSS Conference this week in Orlando have all been carefully shaded with lots of qualifications about what may or may not happen in Washington, D.C. or in the country, in the coming months and years. In that context, any conversation with a federal healthcare official can provide worthwhile intelligence for the road ahead.
Andrew Gettinger, M.D., CMIO in the Office of the National Coordinator for Health IT (ONC), an agency within the Department of Health and Human Services, made himself available on the spur of the moment on Sunday, Feb. 19, to HCI Editor-in-Chief Mark Hagland, during HIMSS17. Gettinger has been at ONC for two-and-a-half years. Prior to that point, he had had a broad range of professional involvements: he practiced anesthesiology and critical care medicine for more than 30 years, before becoming CMIO at Dartmouth-Hitchcock Health in New Hampshire, and then working as a Robert Wood Johnson Foundation fellow in the office of Sen. Orrin Hatch (R-Ut.). Below is an excerpt from their interview.
What are your key areas of interest right now within ONC?
We’re in a window of time right now when leadership is changing, but what I’ve heard from the clinical community and almost every stakeholder in healthcare is that there’s too much of a regulatory burden on clinicians, and we’re going to be looking at opportunities to reduce that burden, and there are many opportunities. For example, when there are requirements for clinicians, doctors in particular, but also nurse practitioners and PAs [physician assistants], to put things in the chart that they wouldn’t otherwise—for example, an ophthalmologist being asked to record immunizations—that’s just not what they do—it’s a burden. It’s important to us to know who’s had immunizations, but that’s not the right member of the care team to be required to document immunizations, so that’s one example of where we can sort things out. We’re also segueing from care being provided primarily by individual practitioners to care being provided by care teams that will be able to take some of the burden off individual physicians.
The letter that CMS [the Centers for Medicare and Medicaid Services] last week published on its website, asking providers to offer suggestions around the “improvement activities” in the MIPS [Merit-based Incentive Payment System] program. Might that be one example of what you’re talking about?
I’m not authorized to speak on behalf of CMS. On the other hand, I’ve watched and heard what our CMS colleagues are doing, and they are very focused on improving what is required from the clinical community. And a couple of key themes that have emerged are flexibility, a longer transition into MIPS—this is the flexible year. But the notion of shorter timeframes for measurement, is again a step towards improve decreasing the burden of regulation. This is a ‘goal’ statement on my part—and it doesn’t necessarily represent the views of my agency, the government—but I’d like to see a quality reporting system where what you’re able to submit is the result of what you would be collecting anyway, to provide care. So that the quality reporting would be a derivative, and not an independent task of what I’d have to do where I’d have to hire somebody.
Might greater flexibility for clinicians be a theme for clinicians in the next year or two, in federal healthcare?
I’m not sure. Perhaps, but maybe not. It really depends on what the leadership in federal agencies decide.
What should the ongoing interactions among stakeholders be like, ideally, going forward, in your view?
The healthcare ecosystem is dramatically dependent on all the parties being able to figure out what their priorities are. The government wants to make sure that care is safe, and that health IT as we develop it, is able to support safer care, and that the health IT in itself is safe. Those are really important themes. I’ve already mentioned that quality is a derivative, and should be. Doctors want to get back to taking care of patients. I can’t imagine that we wouldn’t be supportive of that. But that also means that other groups need to be at the table—specialty societies, for example. What is important for a urologist to do, a cardiologist to do? I think the specialty societies will do some of that work [of convening discussions among stakeholder groups to move forward in these areas.] I think many other large third-party payers will interact with the government, as is already happening under CMS’s leadership—and that’s good. Because if you’re just a person taking care of patients, and you have to submit this data here, and that data there, it becomes bewildering. Simplification. People talk about 30-35 percent of the healthcare dollar being non-beneficial; so, trying to get at that 30-35 percent is very important.
