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D.C. Report: Early Look at Meaningful Use Stage 3 Recommendations

August 7, 2012
by Jeff Smith, Assistant Director of Advocacy at CHIME
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Meaningful Use Stage 3 Recommendations Get Preliminary Look MeaningfulUse watchers this week were given a present from the Health IT Policy Committee’s MU Workgroup as preliminary recommendations for Stage 3 were released.  According to workgroup members, Stage 3 would see a general increase in thresholds, new EHR functionalities, “consolidation” of previous objectives and a continuing trend to move menu objectives to core.  The subgroup categories (there are four in Meaningful Use, e.g. “Improve Quality Safety, Efficiency and Reducing Health Disparities,” would also be bulked up with more complex objectives.  Of particular note are those objectives surrounding “engaging patients and their families” and “improving population and public health,” both of these subcategories have a number of new or more defined objectives and measures.  In addition, the concept of a “care plan” is more fully defined.  Below is a sampling of new objectives and measures:

·         Use computerized provider order entry for more than 20% of referrals/transition of care orders;

·         Implement 15 clinical decision support interventions related to five or more clinical quality measures;

·         Provide 10% of patients with ability to submit information, such as medical device data;

·         Capability to receive a patient’s immunization history supplied by an immunization registry or immunization information system;

·         Capability to electronically send standardized Healthcare Associated Infection (HAI) reports to the National Healthcare Safety Network (NHSN)

In addition to providing preliminary recommendations for Stage 3, committee members also presented some objectives that are stage undetermined, while others were clearly set aside as a “Stage 4 Placeholder.”  The MU Workgroup said they plan to distribute a Request for Comment in November with responses due by December 21, 2012.  The plan is to transmit final recommendations for Stage 3 to HHS in May 2013.  Here are some other recommendations from related workgroups.

Think Tanks Debate ACA 2.0 in Washington This week, the New England Journal of Medicine release two papers written by prominent Washington-based think tanks, teeing up a debate about how to reduce healthcare costs.  The left-leaning Center for American Progress (CAP) outlined a number of reforms that supporters – like CAP senior fellow Ezekiel Emanuel, and including former CMS chief Don Berwick, former OMB Director Peter Orszag and former Senate Majority Leader Tom Daschle – say will bend the “cost curve.”  The authors advocate for an approach that partly relies on government to move providers and insurers away from fee-for-service waste. Chief among their ideas is a push to require insurers and providers to negotiate rates within a budget, known as a global spending target, to prevent open-ended fee-for-service arrangements. The plan would also move most of Medicare and Medicaid away from fee-for-service payments within 10 years. Advocates for the new approach say their proposal represents “the next generation” of reforms intended to prevent health care costs from consuming a greater share of the national economy.

On the other side of the isle, American Enterprise Institute (AEI) also released a paper meant to achieve long-term cost savings in healthcare.  Joe Antos, University of Pennsylvania scholar Mark Pauly and Bush-appointed CMS Administrator Gail Wilensky said in their paper that Medicare should move to a defined contribution approach instead of continuing with the defined benefit system.  They proposed giving seniors and other beneficiaries a uniform subsidy that they could use to buy insurance from competing health plans or traditional fee-for-service Medicare. All of the coverage would offer a common set of core benefits.  The authors also said the current tax exclusions on health insurance provided by companies to their workers are ineffective.  Instead, they could be converted into a tax credit that could be used by individuals to buy insurance on their own.

CMS Fraud ‘Command Center’ Comes Under Senatorial ScrutinyTwo Senate Finance Committee Republicans' – Sens. Orrin Hatch (Utah) and Tom Coburn (Okla.) – sent a letter to CMS Administrator Marilyn Tavenner earlier this week, voicing concerns that the agency's new predictive analytics hub, which pulls together all aspects of the agency's program integrity efforts, may not be necessary.  Sens. Hatch and Coburn say CMS should be doing more and cite three specific categories of concerns related to the Fraud Prevention System: the performance metrics to assess the effectiveness of FPS, the targeting of claims for reviews, and transparency about results from the system.  “CMS can be more transparent with how it is handling the resources it has been allocated for the purposes of enhancing program integrity,” the letter agues. In response to the letter, CMS Deputy Administrator for Program Integrity Peter Budetti says the agency's new anti-fraud Command Center will pay for itself many times over.