On July 29, Rep. Renee Ellmers (R-NC) introduced into the U.S. House of Representatives a bill that would reform the meaningful use program under the HITECH (Health Information Technology for Economic and Clinical Health) Act and delay rulemaking for Stage 3 of meaningful use. The bill is known as the “Further Flexibility in HIT Reporting and Advancing Interoperability Act,” or the “Flex-IT 2 Act.” Also last week, Rep Tom Price (R-GA) hosted a town hall meeting with the American Medical Association to discuss electronic health record (EHR) adoption challenges for physicians.
These developments are taking place against a backdrop of increasing frustration on the part of hospitals and physicians with the path of the meaningful use program. As the healthcare industry moves toward the time, most likely this autumn, when the Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health IT (ONC) will release the final rule for Stage 3 of meaningful use, providers are becoming increasingly concerned about timelines and other issues.
Currently, leaders at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) have been working with members of Congress to try to get changes made to the meaningful use program via legislation.
Among the chief concerns, embedded in the Ellmers bill, that CHIME leaders are trying to bring forward to members of Congress and to the committees dealing with healthcare policy issues, according to Leslie Krigstein, interim vice president of public policy for CHIME, including the following:
- CHIME leaders are pushing for the alignment of meaningful use rulemaking with other programs, particularly with the requirements that are being developed for the new Merit-Based Incentive Payment System (MIPS), which was created under the new Medicare and CHIP Reauthorization Act (MACRA) passed in April and signed into law by President Obama. That legislation targets meaningful use requirements under HITECH, along with quality, resource use, and clinical practice improvement outcomes in physician practice, as key areas for incentivization. CHIME leaders want a pause on MU Stage 3 and new certification requirements until the majority of participants are successful in the current program or the final regulations implementing the MIPS program are issued by CMS, for dovetailing of the requirements of the two programs.
- CHIME leaders want CMS and ONC to abandon the “pass/fail” approach to meaningful use compliance model under meaningful use, and incentivize participation by creating a rewards schematic that recognizes the different conditions for different hospitals and physicians.
- CHIME leaders what CMS and ONC to streamline quality reporting, eliminating duplicative quality reporting requirements, and deeming participants who have successfully met more robust physician hospital quality reporting requirements as having met the meaningful use quality requirements.
- CHIME leaders want CMS to expand the “unforeseen circumstances” hardship provision to provide an exemption for providers who want to switch certified EHR products; provide an exemption for providers who experience a cyber-attack or other disruptive technological problems; and provide an exception for certain physicians based on their specialty or based on their approaching retirement.
- CHIME leaders also see as a key barrier to interoperability the fact that certification does not ensure that data is sent, received and seamlessly incorporated across HER systems. They want that process of interoperability to be prioritized. And they want CMS to implement a 9-day reporting period for 2015 and beyond, to facilitate innovation, remove barriers to interoperability, and promote usability.
Krigstein spoke on Monday with HCI Editor-in-Chief Mark Hagland regarding all of these developments. Below are excerpts from that interview.
Tell me about the background to the Ellmers bill?
This bill has been a long time coming. It’s really viewed as a provider proposal to improve the meaningful use program, building on the coalition that informally came together as a result of the 90-day bill from the last Congress. And then Congresswoman Eller brought together that same coalition—us, the AMA [American Medical Association], AAFP [American Academy of Family Physicians], MGMA [Medical Group Management Association], and America’s Essential Hospitals, the safety net hospitals. We are the supporting group. There was the sense that we would wait for Stage 3 and see what CMS’s response was to provider concerns surrounding meaningful use. So once we saw the proposed rule for Stage 3 in late March—and the comment period close din late May—we waited for the comments to come out, and then we said, there’s still a need for greater flexibility, and CMS hadn’t listened closely enough to our concerns.
What is at the core of Rep. Ellmers’ bill?
There are five major provisions of the bill, as enumerated in your bullet-point information in this interview, above.
Has anyone introduced a version of the Ellmers bill in the Senate?
No; there have been conversations, but as of now, there hasn’t yet been a companion bill introduced in the Senate.
What will happen in Congress in the next few months?