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D.C. Report: CMS Announces HIPAA 5010 Compliance Delay

March 19, 2012
by Jeff Smith, Assistant Director of Advocacy at CHIME
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CMS Announces Another HIPAA 5010 Compliance Delay In an announcement made Thursday, the Centers for Medicare and Medicaid Services (CMS) said it will further delay enforcement of HIPAA 5010 standards until June 30, 2012.  In November, the CMS Office of E-Health Standards and Services (OESS) announced a 90-day period of enforcement discretion “based on industry feedback revealing that, with only about 45 days remaining before the Jan. 1, 2012 compliance date, testing between some covered entities and their trading partners has not yet reached a threshold whereby a majority of covered entities would be able to be in compliance by Jan. 1.”  The OESS continued, saying, they have also received reports that many covered entities are still awaiting software upgrades.

The Thursday announcement is an “extension of enforcement discretion” that gives HIPAA covered entities an extra 90 days to comply with Version 5010.  “OESS is aware that there are still a number of outstanding issues and challenges impeding full implementation,” the announcement said.  “OESS believes that these remaining issues warrant an extension of enforcement discretion to ensure that all entities can complete the transition. OESS expects that transition statistics will reach 98 percent industry wide by the end of the enforcement discretion period.”

The further delay of enforcement adds to evolving Washington context for Version 5010 and ICD-10.  In early February, under pressure by the AMA, MGMA and other groups, HHS Secretary Sebelius announced that ICD-10 implementation requirements would be extended past its current October 2013 deadline.  As 5010 is a precursor to ICD-10, some believe a path similar to “enforcement discretion” could be in the works for ICD-10, though no new deadline dates have been offered by HHS.

Bill Requires FDA to Establish Unique Device Identifier by end of 2012 Sens. Jeff Merkley (D-Oregon), Charles Grassley (R-Iowa), Michael Bennett (D-Colo.) and Herb Kohl (D-Wis.) introduced a bill that would require the Food and Drug Administration to make a final rule for implantable devices by the end of the year.  The unique device identifier would allow the device to be tracked from creation to implantation.  FDA already sent a proposed rule to make unique device identifiers in July 2011. Unfortunately, this rule has not been approved by OMB and thus has not been published yet. The Office of Management and Budget missed a deadline to issue a rule on the UDI program in October, prompting Kohl and Grassley and Sen. Richard Blumenthal (D-Conn.) to call publicly for its release last month.

MedPac Annual Report Looks at SGR and Other Cost Saving Measures The March 2012 MedPac report, released this week formalized plans to repeal Medicare’s Sustainable Growth Rate (SGR) formula used to set physician reimbursement.  The repeal proposal, first outlined in October 2011, calls for freezing payment rates for primary care services at their current levels for 10 years.  For all specialties, the report, issued Thursday, recommends a 5.9% reduction for three years, then a freeze for seven years.  "The rationale for exempting primary care from fee-schedule cuts comes from recent research suggesting that the greatest threat to access over the next decade is concentrated in primary care services," the commissioners wrote.  The SGR repeal plan would cost about $200 billion, the report said, which is $100 billion cheaper than what the Congressional Budget Office has said a 10-year fix would cost. Most of the difference in cost would come from paying providers less.  MedPAC also recommends equalizing of payments for office visit that take place in hospitals and physician offices.  Office visits in hospitals cost Medicare 80% more than the same 15-minute office visit in a physician’s office.   The Hill reports that teaching hospitals have pushed back on this recommendation claiming that the extra payments help fund a team-based approach to patient care and training of interns.  Hospitals and name-brand prescription drugs aren’t the only ones with something on the line – nursing homes with high rehospitalization rates are recommended to receive reduced payments and the report recommends that payments be shifted from facilities that focus on therapy to those that treat medically complex patients.  MedPac claims if these recommendations are adopted, Medicare could save up to $65 billion over ten years.

Advocacy Community Gets Exclusive Look at Stage 2 Proposed Rules from CMS On Thursday of this week CHIME Members had an exclusive opportunity to hear an overview of Stage 2 meaningful use proposed rules from key CMS staff.  Travis Broome, who is one of the primary authors for Stage 1 and Stage 2 Meaningful Use, gave a 40-minute presentation regarding measures and objectives, clinical quality measures and related payment adjustments, highlighting the rule’s pending changes. (Slides available here).

Of particular interest to CIOs were objectives related to “transitions of care” and “view, transmit and download.”  These two measures appear to be CMS’s hallmark health information exchange and patient engagement pieces, respectively.  The transitions of care objective, in particular, requires robust health information exchange as it would require EPs, EHs and CAHs to electronically transmit summary of care records for more than 10 percent of transitions of care "to a recipient with no organizational affiliation and using a different Certified EHR Technology vendor than the sender..."