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D.C. Report: Senator Calls Attention to ACA Health IT Implications, MedPAC Looks at EHR Incentives

April 12, 2012
by Jeff Smith, Assistant Director of Advocacy at CHIME
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Senator Calls Attention to ACA Delivery Reforms, Health IT Implications A week following Supreme Court oral arguments over the Affordable Care Act, Rhode Island Senator Sheldon Whitehouse wants people to focus attention on parts of the law unrelated to the “individual mandate.”  Prepared for the U.S. Senate Committee on Health, Education, Labor & Pensions, Sen. Whitehouse release a report this week that highlights some of the delivery and payment reforms that have taken place since 2010. The report entitled “Health Care Delivery System Reform and the Patient Protection & Affordable Care Act,” highlights ways that the ACA encourages people to receive preventive care and furthers investments in health IT.  “These reform efforts are the best way to lower costs and improve quality in our health care system,” Sen. Whitehouse said in a news release.  The report specifically focuses on health IT as a priority area for delivery reform saying, “The ACA's payment reforms, pilot projects and other delivery system reforms are built with the expectation of having IT-enabled providers.”  In particular, the shift to new models of care, like ACOs, will rely heavily on information exchange and reporting quality outcomes.  Indeed, the formation of ACOs is contingent on having providers 'online' to transfer information and patient records, and report quality measures.”

CRS Report on Sequestration Spells Relief for CMS Innovation Center Initiatives According to a new report out from the Congressional Research Service, funds allocated for the CMS Innovation Center to test new payment and delivery reform models would be largely spared from mandatory cuts under sequestration.  For those who don’t remember, the Budget Control Act of 2011 (BCA) was the product of negotiations between President Obama and Congress to raise the nation’s debt ceiling last summer.  Congress agreed raised the debt ceiling in return for reducing the federal deficit by at least $2.1 trillion over the 10-year period FY2012-FY2021.  But due to the failure of a joint select committee to negotiate a plan to achieve those cuts, an automatic trigger – sequestration – will come into effect for discretionary spending beginning October 2012.  Under the rules governing sequestration, Medicaid spending would be exempt from any reduction, and cuts to Medicare would be capped at 2%.  The CRS report looks at health spending under the Affordable Care Act and finds “The potential impact of spending reductions triggered by the BCA…appear to be somewhat limited.”  It explains that mandatory appropriations in ACA would, in general, be subject to sequestration, however, only new budget authority for the fiscal year would be reduced.  Unobligated balances carried over from previous fiscal years are exempt from a sequestration order.

In the case of the CMS Innovation Center, ACA provided $10 billion for the FY2011-FY2019 period – and $10 billion for each subsequent 10-year period – for the Innovation Center to test and implement innovative payment and service delivery models.  Because these funds were appropriated prior to the BCA, they are exempt from the 2 percent reduction through sequestration.  The report found, overall, ACA included more than $100 billion in direct appropriations over the 10-year period FY2010-FY2019.

MedPAC looks at EHR Incentive Program The Medicare Payment Advisory Commission (MedPAC) discussed the Medicare EHR Incentive program this week.  During the meeting, commissioners expressed concern about the small number of hospitals and eligible professionals - especially small independent hospitals and physician practices - who have successfully attested to Meaningful Use thus far.  According to data released in hard copy at the MedPAC meeting, 3,280 hospitals, or 58% of eligible facilities, have registered with the program, while 126,321 physicians, or 25% of eligible doctors, have done so. Only 796 hospitals, or 16%, have received payments, along with 31,650 physicians, or 6% of those clinicians.