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CMS Stays Firm on Meaningful Use, ICD-10 Deadlines

February 27, 2014
by Gabriel Perna and Mark Hagland
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On the final day of the 2014 Healthcare Information and Management Systems Society (HIMSS) conference in Orlando, Marilyn Tavenner, R.N., chief administrator for the Centers for Medicare & Medicaid Services (CMS) and Karen DeSalvo, M.D., the National Coordinator for Health IT at the Office of the National Coordinator for Health IT (ONC), spoke to an audience of about 2,000 at the Orange County Convention Center in Orlando. 
While trying to put forth the most flexible face on a number of statements, both Tavenner and DeSalvo made clear that their respective agencies would push forward on a number of key initiatives. Most notably, Tavenner was firm with regard to provider's pleas for timeframe flexibility on meeting the Stage 2 requirements of meaningful use under the HITECH (Health Information Technology for Economic and Clinical Health) Act. 

(Immediately after the conclusion of the morning session, Russell P. Branzell, president and CEO of the College of Healthcare Information Management Executives (CHIME), the association that helped spearhead the Feb. 23 letter to CMS, told Healthcare Informatics exclusively, regarding Tavenner’s statement, “We don’t know what that means. We’re encouraged they’re listening, and we’re encouraged there’s an opportunity for flexibility here. Until we understand what they’re saying, we’re not going to make judgment. And if it doesn’t mean what we hoped, then we’ll continue to look for other opportunities” for adjustments to the meaningful use timeframes.)

"We do expect all Stage 2 providers to meet all requirements in 2015," Tavenner said to the audience. Translation: There will be no extensions of the kind asked for this week by a coalition of 48 healthcare associations.  She did say, though, there would be more flexibility for hardship exemptions. 
Tavenner was similarly strict on the transition to the ICD-10 code-set. "By now folks understand that there will be no more delays. Let's face it guys, we've delayed it more than once and it's time to move on," she said. She did outline a number of steps that CMS will be engaged to support ICD-10 testing, including end-to-testing. 
Recently, the American Medical Association (AMA) restated its efforts to get a delay of the ICD-10 compliance deadline, which is on Oct. 1 of this year. Significantly, Tavenner placed the ICD-10 transition and meaningful use into context by including them on a list of four top action priorities for CMS in 2014, along with the rollout of the so-called "Physician Sunshine Program" and continued work on the federal and state health insurance exchanges. 
DeSalvo Looks Back and Forward
In the first part of the speech, DeSalvo, who was enacted as coordinator approximately six weeks ago, spoke of the accomplishments and successes since the Office of the National Coordinator (ONC) was established as an agency within the Department of Health and Human Services (HHS) by President George W. Bush in 2004 and HITECH was passed in 2009. 
DeSalvo cited statistics that display the progress made in health IT adoption over the past ten years. For instance, she said, since 2008, adoption of electronic prescribing (ePrescribing) has gone from less than 10 percent to two-thirds of all doctors. Doctors are ePrescribing 80 percent of the time, when the requirement is 40 percent of the time, she said.. Also, by the end of 2012, she said, more than half of eligible professionals and 80 percent of hospitals had attested to Stage 1.
"It is clear that HITECH has accelerated progress in this first decade and has been very successful in many ways and is beginning to improve care and the lives of patients in America. It’s helping care to be smarter and more responsive," DeSalvo said. 
DeSalvo looked ahead to the next 10 years in healthcare IT, focusing on life after the meaningful use incentive program ends. She spoke of the importance of creating interoperable data (as well as the standards that enable it), which can move across multiple areas of care coordination for population health management. 
"Meaningful use is just one tool to incentivize data, states can do the same," she said, citing the work she was involved with in Louisiana, as part of the Crescent City Beacon Community program, and other efforts in New Orleans. There, healthcare leaders used population health management to enroll 250,000 patients in chronic care programs around diabetes and heart failure and connect 17 provider organizations within a health information exchange (HIE). "This is just some of the progress that the worst state in the nation [in terms of healthcare cost and quality] made," and that progress, she stressed, emphasizes how much potential there is for similar progress nationwide.