For U.S. Physicians, the Healthcare Policy Train Has Already Left the Station

March 21, 2015
With two tremendously significant healthcare policy developments taking place within the same week, no one can doubt any longer the broad direction of federal healthcare policy—especially for practicing physicians

With two tremendously significant healthcare policy developments taking place within the same week, no one who has even the slenderest of connections to federal healthcare policy can doubt any longer that federal health officials and federal legislators know exactly in which direction they’re trying to compel healthcare providers in the coming months and years. It’s clearly in the direction of “the new healthcare,” as I and my colleagues at Healthcare Informatics have been terming it—a U.S. healthcare system in which providers offer, and can document, increased transparency and accountability for the purchasers of care, improved patient care quality and patient safety, and enhanced patient, family, and community satisfaction, all with better care coordination and greater value (improved quality at more cost-effective prices).

What’s fascinating is the degree to which the bipartisan legislation introduced in the House of Representatives on Thursday  to repeal Medicare’s Sustainable Growth Rate Formula (SGR) for physician payment, and instead institute a 0.5-percent payment update for the next five years for physicians, under Medicare, and the release of the proposed rule for Stage 3 of meaningful use under the HITECH (Health Information Technology for Economic and Clinical Health) Act on Friday, mirror each other. Together, the two, if the SGR repeal legislation passes both Houses of Congress and is signed by President Obama, and if the Stage 3 proposed rule ends up looking similar when it becomes a final rule later this year, could revolutionize patient care, particularly the care of patients in physician office and other ambulatory settings.

As I noted yesterday in an analysis of the SGR-repeal legislation, “The legislation targets four key areas: quality, resource use, clinical practice improvement (including care coordination and improvement activities), and the meaningful use of certified EHR (electronic health record) technology.”

What’s more, I noted that the SGR-repeal bill targets “care coordination… such as timely communication of test results, timely exchange of clinical information to patients and other providers, and use of remote monitoring or telehealth, [as well as] beneficiary engagement, such as the establishment of care plans for individuals with complex care needs, beneficiary self-management assessment and training, and using shared decision-making mechanisms, [and] patient safety and practice assessment, such as through use of clinical or surgical checklists and practice assessments related to maintaining certification.”

Meanwhile, the following statement is made by the Centers for Medicare & Medicaid Services (CMS), on page 90 of the 301-page document that is the proposed rule for Stage 3 of meaningful use: “For Stage 3, we generally identified two related policy goals within the overall larger goal of improved patient access to health information and patient-centered communication. The first is to ensure patients have timely access to their full health record and related important health information; and the second is to engage in patient-centered communication for care planning and care coordination. While these two goals are intricately linked, we see them as two distinct priorities requiring different foci and measures of success. “With regard to care coordination, the document further states that “For the second goal, we are proposing an objective entitled Coordination of Care through Patient Engagement (Objective 6) incorporating the policy goals of the Stage 2 objectives related to secure messaging, patient reminders, and the ability for patients (or their authorized representatives to view online, download, and transmit their health information using the functionality of the certified EHR technology.”

Now, two things remain uncertain as of today. First, the SGR-repeal legislation may fail to pass both houses of Congress; very similar legislation was introduced last year and failed. Yet if anything, the federal budget-driven health spending imperatives have become even more pressing in the past year.

As I noted back in October, last autumn, senior actuaries at CMS published their projections for the growth of U.S. healthcare spending, finding that they expect total U.S. healthcare spending to rise from $3.056 trillion last year to $5.158 trillion in 2023, and to eat up 19.3 percent of our nation’s gross domestic product in 2023, compared to 17.2 percent in 2012. Those numbers are absolutely mind-bending, and simply cannot be allowed to be forgotten, or even rationalized, in any discussion of the policy imperatives for U.S. healthcare stakeholders going forward.

Meanwhile, given the mandate under which federal government agencies work to consciously harmonize policy directives as much as possible, it should be no surprise that terms like “care coordination” and “patient engagement” appear throughout both the SGR-repeal legislation and the Stage 3 meaningful use proposed rule. Of course, those terms are fleshed out in sometimes-different ways, when one gets down to the specifics.

But what is abundantly clear is that clinicians, particularly physicians, are going to have to prepare to engage differently with their patients from how they have done so in the past. Among the elements that will be supported by federal healthcare policy going forward will be physicians’ entering their patients into clinical data registries; electronically sharing information from their patient records with their patients, on a continual, ongoing basis; facilitating timely electronic sharing of laboratory and other test results with their patients through electronic messaging means; electronically messaging with their patients more broadly; participating in detailed, robust care coordination and care management with their patients; participating actively in telehealth programs with patients; participating in health information exchange (HIE) with other clinicians on behalf of their patients; and using robust clinical decision support systems. What’s more, on a very grand scale, the current mandate for participation in Medicare’s value-based purchasing program will, if the SGR-repeal legislation is passed, be transformed into an entirely new, and broader, Merit-based Incentive Payment System, or “MIPS” (yes, yet another new healthcare acronym to be learned and memorized).

Of course, Stage 3 of meaningful use will be extremely significant for hospital organizations; of that, there can be no doubt. But as important as it will be to the future of hospitals, Stage 3 will end up being exceptionally impactful for practicing physicians in this country; and anyone who would attempt to minimize its impact would have to be considered foolish.

Above all, when taken together, these two developments in the past week in healthcare policy—the introduction of bipartisan Medicare payment legislation, and the release of the proposed rule for Stage 3 of meaningful use—have the potential to absolutely upend current physician practice as we know it. What will be absolutely essential for healthcare and healthcare IT leaders will be for them to gather together in their organizations and create individual organizational maps for how to get to where federal healthcare leaders want them to get to, on behalf of their patients and communities. Because this map is as clear as it gets. And some of the territory on this map is going to involve some very rocky, challenging terrain. And, as much of a great opportunity as this landscape is for the healthcare IT leaders willing to show leadership, it poses at least that much of a challenge as well, as they will need to help move their physicians, and organizations, forward, very rapidly and yet also very thoughtfully and very strategically. Just don’t let anyone say we don’t know where this train is headed, because the broad outlines have already been mapped out.

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