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Washington Debrief: Lawmakers Want Ideas on Medicare Payment Changes

May 14, 2013
by Jeff Smith, Director of Public Policy at CHIME
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Jeff Smith, Director of Public Policy at CHIME

CHIME Calls for Stage 2 Extension in Letter to Senators

Following a request for feedback from Senators in Washington on the status of health IT adoption, the College of Healthcare Information Management Executives (CHIME) issued a response declaring that a one-year extension of Meaningful Use Stage 2 would “maximize the opportunity of program success.”  The organization of healthcare CIOs said the additional 12-months for meeting Stage 2 “will give providers the opportunity to optimize their EHR technology and achieve the benefits of Stage 1 and Stage 2; it will give vendors the time needed to prepare, develop and deliver needed technology to correspond with Stage 3; and it will give policymakers time to assess and evaluate programmatic trends needed to craft thoughtful Stage 3 rules.”  In calling for an extension to Stage 2, CHIME defended much of the federal incentive program’s progress to date, arguing that fundamental shifts in health IT adoption and EHR product capabilities have been made possible through the policy of Meaningful Use.  “While we share some of your concerns with the current state of interoperability, we strongly believe that EHR incentive payments under the policy of Meaningful Use have been essential in moving the nation’s healthcare system into the 21st Century,” the CHIME letter said. “Through the EHR Incentive Payments program, CMS and ONC have begun to mitigate a fractured and incompatible state for EHRs.”

The response comes amid concerns levied by six Senators that the current direction of the HITECH program is flawed. The white paper released on April 16, “REBOOT: Re-examining the Strategies Needed to Successfully Adopt Health IT,” outlines several concerns including increased health care costs, lack of momentum toward interoperability, patient privacy, and long-term program sustainability.

Lawmakers Want Ideas on Medicare Payment Changes

A bipartisan call came from the Senate Finance Committee this week, asking healthcare providers for input on how to fix the “broken” Medicare payment system.  “The current Medicare physician payment system is inefficient and needs to go,” Senator Max Baucus (D-Mont.) said.  “We need input from all the stakeholders as we move to an improved payment system.  The key is to transition to a more efficient model in a way that safeguards seniors’ access to high-quality care from their doctors.  We can’t do it alone -- we need health care providers to pitch in with their ideas for this process to go smoothly.”  Senator Orrin Hatch (R-Utah) echoed these comments arguing the sustainable growth rate formula is “fundamentally flawed and needs to be permanently fixed.”  Senators Baucus and Hatch are urging health care providers to take a more active role in framing how to improve the current system and help physicians transition to new payment models.  In a letter to stakeholders, the senators are seeking responses to three questions: 

  1. What specific reforms should be made to the physician fee schedule to ensure that physician services are valued appropriately?
  2. What specific policies should be implemented that could co-exist with the current FFS physician payment system and would identify and reduce unnecessary utilization to improve health and reduce Medicare spending growth?
  3. Within the context of the current FFS system, how specifically can Medicare most effectively incentivize physician practices to undertake the structural, behavioral and other changes needed to participate in alternative payment models? 

ONC Publishes Guidance for Health Info Exchange

In June 2012, CHIME submitted comments in responding to an ONC call for information on how best to move forward with nationwide health information exchange governance policies.  The ONC plan would have created “conditions for trusted exchange” meant to address various governance elements, including conditions meant to protect personal health information, technical standards and business practices.  After receiving comment from health stakeholders, including CHIME, cautioning against a new HIE regulatory regime, ONC decided not to move forward with a proposed rule.  Instead, the agency published a Governance Framework for Trusted Electronic Health Information Exchange.  “The Governance Framework reflects what matters most to ONC when it comes to national health information exchange governance and the principles in which ONC believes.  We’ve published this framework to provide a common foundation for all types of governance models.”  The Governance Framework contains many of the same themes listed in the earlier document, without the regulatory burdens previously envisioned.  The four key categories of principles discussed in the Governance Framework include Trust Principles, Business Principles, Technical Principles and Organizational Principles.

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