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Policy Watch: All Eyes on CMS

January 31, 2011
by David Raths
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Divided Congress not Expected to Produce Much Health IT Legislation


Beyond HIPAA privacy and meaningful use Stage 2, regulators must also establish rules involving the health reform act's administrative simplification and care coordination provisions. Policy advocates weigh in on which topics they will be following most closely this year, as well as a few “sleeper” issues that could have a big impact.

In 2010 the advocacy strategic plan for the American Health Information Management Association (AHIMA) was 75 pages long.

As he put the finishing touches on the version for 2011, Dan Rode, AHIMA's vice president of policy and government relations, realized that it was well over 100 pages. “It is going to be a busy year,” he says.

Indeed it is. On several health information technology policy fronts, there promises to be plenty of activity, especially in the regulatory arena. Among the topics on Rode's radar are Stage 2 of meaningful use, final implementation of HIPAA privacy and security rules, ongoing ICD-10 implementation work, and administration simplification rules in the health reform legislation.

Most health IT policy advocates say their focus is shifting from the newly divided Congress to the Centers for Medicare and Medicaid Services (CMS), which is responsible for rulemaking on many of these issues.

“All eyes are going to be on CMS and not on Congress at this point,” says Jennifer Covich Bordenick, CEO of the nonprofit eHealth Initiative in Washington, D.C. “What will impact the marketplace will be the rules and regulations around care coordination,” she adds. The Patient Protection and Affordable Care Act (PPACA) requires CMS to establish rules around accountable care organizations (ACOs) by January 2012. Those rules will involve restructuring reimbursement and value-based purchasing, as well as new quality reporting requirements. “There is a major role for health IT in this,” Covich Bordenick adds, “because it is all about collecting and exchanging data.”

Dave Roberts
Dave Roberts

The intersection of meaningful use requirements and the new ACO landscape will take center stage in 2011, agrees Keith Figlioli, senior vice president for healthcare informatics at the Premier healthcare alliance (Charlotte, N.C.), which focuses on hospital quality and efficiency improvement.


“CMS is starting to write the ACO-specific language right now and there will be a collision point where that will impact meaningful use,” he says. The biggest issue may involve quality reporting because these new organizational constructs will focus on different types of reporting such as readmission rates and their causes. “In 2011 a light bulb is going to go on for people that perhaps the meaningful use requirements and the ACO model are not well aligned,” Figlioli says. Meaningful use is very EMR-centric, but what works within the four walls of the hospital may not be what you need to manage the health of a population, he adds.


Although policy observers expect less action in Congress this year than in the last few, there are still some issues bubbling up. If nothing else, the change in House leadership and the smaller Democratic majority in the Senate are having an impact on perceptions. “We are hearing from some physicians that they are considering not participating in the EHR incentive program because the Republicans have taken over in Washington, and so the stimulus money will be rescinded,” says Dave Roberts, vice president of government relations at HIMSS. He says that is unlikely.

“We have tried to clear up people's misunderstandings about the way Washington works,” he adds. First, it would require both houses of Congress and the administration to agree on something or a congressional override of a presidential veto. None of that seems possible, Roberts says.

Keith Figlioli
Keith Figlioli