On July 29, Rep. Renee Ellmers (R-NC) introduced into the U.S. House of Representatives a bill that would reform the meaningful use program under the HITECH (Health Information Technology for Economic and Clinical Health) Act and delay rulemaking for Stage 3 of meaningful use. The bill is known as the “Further Flexibility in HIT Reporting and Advancing Interoperability Act,” or the “Flex-IT 2 Act.” Also last week, Rep Tom Price (R-GA) hosted a town hall meeting with the American Medical Association to discuss electronic health record (EHR) adoption challenges for physicians.
These developments are taking place against a backdrop of increasing frustration on the part of hospitals and physicians with the path of the meaningful use program. As the healthcare industry moves toward the time, most likely this autumn, when the Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health IT (ONC) will release the final rule for Stage 3 of meaningful use, providers are becoming increasingly concerned about timelines and other issues.
Currently, leaders at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) have been working with members of Congress to try to get changes made to the meaningful use program via legislation.
Among the chief concerns, embedded in the Ellmers bill, that CHIME leaders are trying to bring forward to members of Congress and to the committees dealing with healthcare policy issues, according to Leslie Krigstein, interim vice president of public policy for CHIME, including the following:
- CHIME leaders are pushing for the alignment of meaningful use rulemaking with other programs, particularly with the requirements that are being developed for the new Merit-Based Incentive Payment System (MIPS), which was created under the new Medicare and CHIP Reauthorization Act (MACRA) passed in April and signed into law by President Obama. That legislation targets meaningful use requirements under HITECH, along with quality, resource use, and clinical practice improvement outcomes in physician practice, as key areas for incentivization. CHIME leaders want a pause on MU Stage 3 and new certification requirements until the majority of participants are successful in the current program or the final regulations implementing the MIPS program are issued by CMS, for dovetailing of the requirements of the two programs.
- CHIME leaders want CMS and ONC to abandon the “pass/fail” approach to meaningful use compliance model under meaningful use, and incentivize participation by creating a rewards schematic that recognizes the different conditions for different hospitals and physicians.
- CHIME leaders what CMS and ONC to streamline quality reporting, eliminating duplicative quality reporting requirements, and deeming participants who have successfully met more robust physician hospital quality reporting requirements as having met the meaningful use quality requirements.
- CHIME leaders want CMS to expand the “unforeseen circumstances” hardship provision to provide an exemption for providers who want to switch certified EHR products; provide an exemption for providers who experience a cyber-attack or other disruptive technological problems; and provide an exception for certain physicians based on their specialty or based on their approaching retirement.
- CHIME leaders also see as a key barrier to interoperability the fact that certification does not ensure that data is sent, received and seamlessly incorporated across HER systems. They want that process of interoperability to be prioritized. And they want CMS to implement a 9-day reporting period for 2015 and beyond, to facilitate innovation, remove barriers to interoperability, and promote usability.
Krigstein spoke on Monday with HCI Editor-in-Chief Mark Hagland regarding all of these developments. Below are excerpts from that interview.
Tell me about the background to the Ellmers bill?
This bill has been a long time coming. It’s really viewed as a provider proposal to improve the meaningful use program, building on the coalition that informally came together as a result of the 90-day bill from the last Congress. And then Congresswoman Eller brought together that same coalition—us, the AMA [American Medical Association], AAFP [American Academy of Family Physicians], MGMA [Medical Group Management Association], and America’s Essential Hospitals, the safety net hospitals. We are the supporting group. There was the sense that we would wait for Stage 3 and see what CMS’s response was to provider concerns surrounding meaningful use. So once we saw the proposed rule for Stage 3 in late March—and the comment period close din late May—we waited for the comments to come out, and then we said, there’s still a need for greater flexibility, and CMS hadn’t listened closely enough to our concerns.
What is at the core of Rep. Ellmers’ bill?
There are five major provisions of the bill, as enumerated in your bullet-point information in this interview, above.
Has anyone introduced a version of the Ellmers bill in the Senate?
No; there have been conversations, but as of now, there hasn’t yet been a companion bill introduced in the Senate.
What will happen in Congress in the next few months?
One thing we had in mind is that the HELP Committee [Committee on Health, education, Labor, and Pensions] and their Health IT Working Group have spent a lot of time thinking and talking about meaningful use, and Committee Chair Alexander [Lamar Alexander (R-TN)] has suggested a delay in Stage 3. So we wanted Rep. Ellmers to be able to propose this and have the Senate look at this. The 21st-Century Cures bill talked about interoperability, certification, and standards, but avoided specifically addressing meaningful use, including structure, timeline, or eligibility changes. We were hoping that these elements had been introduced into the 21st-Century Cures bill, because you really can’t divorce interoperability from meaningful use, so divorcing the two isn’t wise in our view, but it did happen. So as a result of that, we picked up this element in this new bill. And Congresswoman Ellmers is a nurse, and her husband is a surgeon, so she has a provider perspective on this.
Given those developments what might happen next?
I think this will begin the conversation around meaningful use reform, both in the House, and based on some of the conversations we’ve heard in the Senate. Based on discussions that will happen while members are in their home districts, I think the conversation will progress. I think that the HELP Committee will explicitly discuss meaningful use, and that many of the elements in Congresswoman Ellmers’ bill will have some presence. Because I don’t think any of these ideas are outlandish or unreasonable. They’re fairly concise and definitely representative of provider concerns. So whether they look like how they do in this bill or take a different shape, I think most of these will be addressed in some capacity.
Do you think your coalition will succeed in getting some significant modifications to the final rule for Stage 3?
I think the timeline piece is the most critical, because we’ve heard that CMS is still planning to move forward with Stage 3 in its current planned timeline. So this is an attempt for a committee member with jurisdiction to go on record with concerns. And if CMS attempts to move forward with the predicted timeline, there will be a louder chorus of concern. And at least this bill will start the conversation; and that’s all we can ask for. And we hope the House can engage in conversation as well. Sen. Alexander is speaking regularly with Dr. DeSalvo [Karen DeSalvo, M.D., National Coordinator for Health IT] and Secretary Burwell [Health and Human Services Secretary Sylvia Mathews Burwell]. So this really is a starting point. And I think more conversations have to happen. I think it’s really a matter of going on the record with some actionable solutions. And that will hopefully get CMS’s attention.
The final rule is going to be released when, for Stage 3?
I’ve heard this fall. I’ve heard the modifications rule will be out in late September; so the final rule should drop in the October-November timeframe—especially given the optional nature of 2017. Stage 3 does make a number of substantive changes that will force developers to make software modifications.
What should CIOs, CMIOs, and other healthcare IT leaders think about the current legislative landscape on Capitol Hill right now?
There seems to be a fair amount of harmony in the messaging from the provider community. We’re seeing the same level of concern among all providers; and the desire to be successful. The provider community isn’t asking for this program to go away; there’s immense opportunity in seeing the MU program be successful. So we’ve tried to offer reasonable, actionable improvements to the program, and hopefully, there will be some recognition at CMS and ONC that there is a very sincere interest in the provider community in making this program a lasting success, but that we need some significant changes in order to really make this a learning healthcare system. Especially looking at the MIPS Program, for example, meaningful use is a very big component of that. And unless we can make that program and MU aligned, we’re going to run into some problems. I think making the chances now will be much more beneficial than having this ongoing frustration moving forward.
Is there anything you’d like to add?
I think that interest in fixing the program is something that we will continue to hear about. Budget Chairman Rep. Tom Price (R-GA) mentioned concern, expressed in a Ways and Means Committee hearing, that CMS needs to provide metrics for Stage 2; he said he didn’t think there was proper evidence to move ahead with Stage 3 rulemaking. And he’s a pretty powerful member of the House. This current bill may not be the silver bullet, but there will be an ongoing need for changes. And Stage 2 will change fairly considerably with the modifications rule, which changed things to allow for the 90-day reporting period, and eliminated some of the quality measures, and tried to align more with Stage 3. That was a pretty considerable change to the program; and being able to properly evaluate what the modifications have looked like before leaping into Stage 3 would be helpful.