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.

Authors of the Sunshine Act Ask CMS to Implement Final Regulations The October 1, 2011 deadline to implement the Physician Payments Sunshine Act has come and gone, yet CMS still hasn’t released the final rule on implementation.  The law’s authors, Senators Chuck Grassley (R-Iowa) and Herb Kohl (D-Wis.), wrote a letter to CMSthis week asking them to implement final regulations no later than June 2012.  This rule requires greater transparency of transactions between pharmaceutical and device companies and health care providers.  For this information to be useful, the Senators are calling on CMS to present a final rule that would offer data in a way that is accessible and understandable to the public.  With the implementation of this act, a website will be created to publicize transactions between pharmaceutical and device companies and healthcare providers.  In the proposed rule, CMS suggested that data errors on the site be corrected once a year, but the letter from Sens. Grassley and Kohl ask that they update the system as soon as they are notified about an error.  And to prevent confusion, the Senators are urging CMS to make the website as user friend as possible, to disclose data in a sortable fashion as well as name the brand companies associated with smaller subsidiary manufacturers when listing transactions. The senators also say a strong outreach campaign will be needed after a survey in March 2012 found that 47 percent of physicians and compliance officers have never heard of the Sunshine Act.

NeHC releases “Health Information Exchange Roadmap: The Landscape and a Path Forward”

During a webinar this week, NeHC released a roadmap on health information exchangein an effort to achieve interoperable HIE.  The roadmap includes a four phase process about how a successful health information exchange can be developed based on experiences and best practices of nine exchanges reviewed in the paper.  A product of the collaboration of 75+ experts and industry leaders, the roadmap says, with proper implementation “HIE will revolutionize the practice of transitions of care and connected health, which have long been difficult to manage.”

The paper explores the progress of nine exchanges, some private and some public, and some that use Direct and Connect programs.  The roadmap acknowledges that vendors have different capabilities, but systems are starting to work together.  A presenter on the webinar said that care coordination – tracking care management, and exchanging patient information with all providers that care for a patient – is the biggest priority of their HIE, and that they are very focused on data integrity.  Laura Adams of the Rhode Island Quality Institute explained that they are using DIRECT to get information into their HIE, and to get analytics reports.  She said, “We are proactively providing care, not just reacting. Our system is telling people when an event is happening – primary care physicians get a note from the HIE if their patient went to an emergency room.”

NeHC also launched an HIE Learning Network on the webinar to accelerate the advancement of HIE.