CHIME, NAACOS Respond to Senate HELP Committee’s RFI on Rising Healthcare Costs

March 4, 2019
CHIME is calling for more stringent privacy and security standards in policy recommendations, while NAACOS wants to ensure the Medicare Shared Savings Program remains strong

Healthcare associations have written to the Senate Committee on Health, Education, Labor, and Pensions (HELP), responding to committee Chairman Lamar Alexander’s (R-Tenn.) request for information to address healthcare’s rising costs.

In December, Alexander remarked that “up to half of healthcare spending is unnecessary,” while asking for as many specific legislative, regulatory, or sub-regulatory solutions as possible, in writing, by March 1. More recently, it was revealed by CMS (Centers for Medicare & Medicaid Services) actuaries that national health expenditure growth is expected to average 5.5 percent annually from 2018 to 2027, reaching nearly $6 trillion by 2027.

In its comments, the College of Healthcare Information Management Executives (CHIME), the Michigan-based association that represents more than 2,800 CIOs and other health IT senior leaders, noted that costs to maintain EHR (electronic health record) systems “and ensure they are capable of enabling successful participation in federal programs comes with steep price tags.”

The letter from CHIME pointed out that requirements of the Promoting Interoperability (PI) program, formerly known as meaningful use, “shift frequently, leaving both vendors and health systems in a constant state of development and implementation.” CHIME added, “Congress must work with the administration to continue to infuse flexibility into the PI program, so it better aligns with patient and clinician needs.” To this end, CHIME, as it has before, also is pushing for the harmonization of measures across CMS programs, which “would free up resources within health systems and technology providers for innovation.”

Regarding security, CHIME noted that “we must ensure the implementation of stringent privacy and security standards,” and the association is calling upon the committee to address the growing nature of cybersecurity threats to patient data and ensure that security is included in any policy recommendations.

Specifically, CHIME said, the complexities with meeting HHS (Department of Health & Human Services) privacy and security requirements “can be staggering.” The comments went on, “Audits by the Office for Civil Rights (OCR) are perceived as being punitive and not assisting the organization to recover and learn from a breach. Providers today must dedicate highly valuable resources to navigate a complex and often unbalanced and punitive regulatory landscape. Resources and efforts are often focused on compliance with OCR requirements, which may not always represent the greatest threats faced by a healthcare provider, diminishing rather than aiding their ability to guard protected health information (PHI).”

And to further enhance proactive collaboration, CHIME wrote that “safe harbors from resolution agreements as an incentive for organizations that demonstrate, and certify, cybersecurity readiness should be offered, which may warrant Congress to amend provisions of the HITECH Act.”

According to CHIME, this will “encourage the investment into cybersecurity from the providers in an age when it is understood no organization can prevent all cybersecurity attacks.” Further, CHIME said, “it may be necessary for Congress to consider revising some of the definitions set forth in HITECH, such as the definition of a breach, as to not presume guilt.”

CHIME also offered that in its cybersecurity assessments, OCR should acknowledge provider efforts and investments to safeguard information and information systems. “HHS should be encouraged to pursue policies which reward providers and other covered entities for engaging in good faith efforts to prevent cybersecurity attacks rather than unduly punitive ones,” the association wrote. Providers should also be able to maximize protections allowed under business associates agreements (BAAs) by redistributing responsibility for security more evenly among covered entities and their business associates (BAs), CHIME said.

Also as it has before, CHIME is pushing for  a standard patient identifier, noting that “While a national approach to patient matching would be an important step toward true interoperability, without a standard patient identifier, the creation of a complete and accurate longitudinal care record is simply not feasible.”

Other cost-cutting recommendations from CHIME included:

  • Helping states align privacy and consent policies—namely, HIPAA and 42 CFR Part 2—that enable cross-border exchange of health information in a secure manner, including SUD (substance use disorder) data
  • Rewarding long-term care facilities and behavioral health providers with incentive payments for using certified EHR technology
  • Allowing licensed healthcare providers to offer services to patients, using telemedicine, regardless of what state a patient resides in, while realigning federal payment structures around telemedicine
  • “True” price transparency so that clinicians and patients could be armed with more information about the costs associated with a procedure or treatment

NAACOS Weighs In on ACOs

Meanwhile, NAACOS (the National Association of Accountable Care Organizations), the largest association of ACOs, is calling on Congress to continue to ensure that the Medicare Shared Savings Program (MSSP) remains strong and encourages robust provider participation.

In a final rule released in December, CMS announced its intentions to more forcefully  push ACOs into two-sided risk models, as the government doesn’t believe that one-sided risk ACOs are saving Medicare money. But as NAACOS has commented, the final rule “will present challenges to providers who want to participate in this important, yet voluntary, Medicare program. NAACOS believes there needs to be movement toward assuming risk, and that movement requires an appropriate and reasonable glide path to encourage participation and success.”

Specifically, NAACOS is concerned with a few key elements of the rule: 1) that CMS decreased the shared savings rate to 40 percent from 50 percent for certain one-sided risk ACOs; 2) that CMS finalized a two-year limit for certain ACOs in one-sided risk models, a decrease from the prior duration of six years; and 3) that CMS finalized a “high-low revenue” ACO distinction which NAACOS attests will deter providers who want to embark and stay on the path of value-based care.

NAACOS, unlike CMS, believes that one-sided risk ACOs do indeed generate financial savings for Medicare, as the organization pointed out in its comments that “Since 2013, the first full year of the MSSP, ACOs have generated overall savings of $2.66 billion to Medicare, well above the $1.6 billion calculated by CMS. After accounting for the shared-savings payments earned by ACOs, MSSP net savings were $665.8 million in the program’s first four full years—not a loss of as estimated by CMS.”

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