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Washington Debrief: Sen. Alexander says EHR Improvements Are Top Priority

June 1, 2015
by Leslie Krigstein, Interim Vice President of Public Policy
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Leslie Krigstein, Interim Vice President of Public Policy

Top News

Senate Hearings to Investigate Ways to Improve EHRs

Key Takeaway:  Senate Health, Education, Labor and Pensions Committee Chair Lamar Alexander (R-T.N.) said making electronic health records (EHRs) work for clinicians and scientists is among his top priorities during a visit to Vanderbilt University last week.  He and HELP Ranking Member Sen. Patty Murray (D-Wash.) have established a bipartisan workgroup to identify ways to improve EHRs.

Why it Matters:  The HELP Committee has long been engaged with the health IT stakeholder community and is currently working on policies meant to enable efforts like the President’s Precision Medicine Initiative.  This latest announcement of a bipartisan workgroup likely portends hearings and legislation meant to address lingering challenges with interoperability.

According to HELP Chairman Alexander and Ranking Member Murray, the Senate will go “more in depth” than the House Energy and Commerce (E&C) Committee to fix problems with EHR systems built with $30 billion in federal incentive payments.  During a Vanderbilt University workshop on creating a million-patient precision medicine database, Sen. Alexander said a bipartisan group of staff had been meeting weekly with staff from ONC and the office of NIH Director Francis Collins to identify ways to improve EHRs.  As part of this work, summer hearings are being planned and Mr. Alexander urged scientists to bring specific ideas forward by September to incorporate into Senate legislation next year, meant to mesh with the House Energy and Commerce Committee’s 21st Century Cures Initiative.  There are, as yet, no dates set for hearings.


EHR Incentive Program Crosses $30B Threshold

Key Takeaway:  According to CMS data, more than $30 billion in incentive payments have been disbursed to eligible hospitals, eligible professionals and critical access hospitals since the program began in 2010.

Why it Matters:  Original estimates by the Congressional Budget Office (CBO) expected roughly $31.2 billion in incentives to be spent by CMS through 2017, before federal number crunchers recouped some $1.1 billion through penalties for noncompliance.  With 2016 representing the last year that providers participating in the Medicare program can receive incentives, health IT executives should have a firm grasp of what on-going maintenance and compliance costs will be, moving forward.

CMS data released last week, and current through the month of March, gave stakeholders a macro view of how the EHR Incentive Program has fared more than five years since passage of HITECH.  According to CMS, more than $30 billion in incentive payments have been paid, and:

  • $20.2 billion paid through Medicare;
  • $9.4 billion paid through Medicaid; and
  • $400 million paid to Medicare Advantage.

Moreover, the data detailed how many unique providers have received incentive payments, which could be for meeting the Medicare meaningful use criteria or for meeting Medicaid “adopt, implement or upgrade” criteria.  Numbers indicate that roughly 429,000 EPs and 4,800 EHs have received payments, which represent roughly 80 percent of all EPs and 96 percent of all EHs / CAHs.  The data breakdown also finds that roughly 7 percent (38,472) of all EPs have successfully met the requirements of meaningful use Stage 2.  And approximately 29 percent (1,440) of EHs have met Stage 2 requirements.  It should be noted that not all EPs and EHs / CAHs are eligible to meet Stage 2 criteria in 2014 or 2015.  Separate CMS analysis indicate that roughly one-third of EHs scheduled to meet Stage 2 in 2014, and more than two-thirds of EPs, opted to meet MU using alternative pathways.  With CMS expected to finalize proposals that would shorten the 2015 EHR reporting period to 90 days and slide hospitals from a fiscal year to a calendar year, stakeholders will not know how providers fared in 2015 until well into 2016.

Legislation & Politics

21st Century Cures Unanimously Passes House Committee, Future Uncertain

Key Takeaway:  The legislation know as 21st Century Cures, or H.R. 6, passed the Energy & Commerce Committee recently with the full support of all 51 Republicans and Democrats. Several sections will directly impact health IT policy should the Senate take up similar language.

Why it Matters:  Sections 3001 and 2241 – 2243 would codify new provisions meant to improve interoperability of health IT and prohibit FDA from regulating most health IT functionality, respectively.  As these measures are considered by the Senate, healthcare IT executives should understand how these sections could impact their day-to-day lives.