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A Cloudy HIT Policy Picture is Beginning to Clear Up

May 29, 2018
by Rajiv Leventhal
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While there are many concurrent winds blowing in the health IT policy and payment world, the administration has taken a hard stance on many key areas

Although the health IT policy and payment landscape has plenty of moving parts, and continues to be fluid, one of the core principles that has not wavered among federal health administrators under President Trump has been a sustained emphasis on moving toward a market-driven value-based healthcare system in which consumers will be at the center of their care.

Indeed, at this time last year, healthcare stakeholders were filled with uncertainty, as the future of healthcare policy remained very much in limbo. But in the past several months, an air of stability has presented itself, and while providers, purchasers and payers undoubtedly still have their fair share of questions, things seem far more solidified than they did just one year ago. Consider the following:

  • In September 2017, Tom Price, M.D., resigned as Department of Health and Human Services (HHS) Secretary. Price, who only served in the role for about seven months, was replaced in January by Alex Azar, a former pharmaceutical industry executive who in just the last two months has been clearer about his desire to accelerate value-based transformation than perhaps Price ever was. “HHS has made shifting our healthcare system to one that pays for value one of our top four department priorities,” Azar recently said.
  • One of the clear themes of this year’s HIMSS (the Healthcare Information and Management Systems Society) conference was the federal administration’s public push toward a free market healthcare in which the patient is empowered through greater interoperability and access, as well as removing government burdens. Federal health officials said at the HIMSS conference, and elsewhere in recent weeks, that reducing clinician burden—such as the documentation stress that EHRs (electronic health records) cause, as well as the piled-up stacks of requirements from regulations and mandates over the years that must be processed—will enable providers to perform better in value-based payment programs, thus directly affecting their reimbursement.
  • Finally, year two of the Quality Payment Program (QPP), under the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) law is underway, and in several instances, providers are asking for further flexibilities so that they continue to ease their way into a new era that pays them for the quality of care they provide rather than the volume of services rendered. What’s more, talk about a possible MIPS (the Merit-based Incentive Payment System, one of the two payment tracks under the QPP) repeal have ramped up, thanks to a recent Medicare Payment Advisory Commission (MedPAC) report to Congress, advocating for the elimination of MIPS and replacing it with an alternative model of reimbursement. But despite these MACRA/MIPS uncertainties right now, there is absolutely no talk about eliminating MACRA—a stark contrast from just a year ago.

When considering all of the policy and payment moving parts, one critically important point to keep in mind is that MACRA/MIPS for clinicians, and meaningful use for hospitals, are required activities, and for the most part, says Jeff Smith, vice president of public policy for the Bethesda, Md.-based AMIA (the American Medical Informatics Association), CMS (the Centers for Medicare & Medicaid Services) “is operated by virtue of the federal register, and there are almost immovable timelines by which change can happen.” What’s more, says Smith, “Over the last 18 months or so, there was definitely a period of time when the new administration was getting into place and officials from CMS and ONC (the Office of the National Coordinator for Health IT) started to get familiar with their surroundings. So, in 2018 we will start to see some of the fingerprints of the new administration make their way onto the policy landscape.”

Jeff Smith

What 2018 Has in Store

The 2018 QPP final rule under MACRA dropped last November, giving eligible clinicians just two months to get ready for the new reporting year. But questions have already emerged about the future of MIPS, following the MedPAC report to Congress, advocating for its elimination and replacing it with an alternative model of reimbursement. As Healthcare Informatics reported at the time, “MedPAC [a nonpartisan legislative branch agency that provides the U.S. Congress with analysis and policy advice on the Medicare program] submits two reports to Congress each year, in March and in June. Back in January, MedPAC voted 14 to 2 to recommend scrapping MIPS and replacing MIPS with a new clinician value-based purchasing program, called the Voluntary Value Program (VVP), and this proposal was included in the advisory group's recent report to Congress.”

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