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D.C. Report: CHIME Reacts to Congressional Calls to Suspend Meaningful Use

October 16, 2012
by Jeff Smith, Assistant Director of Advocacy at CHIME
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Jeff Smith, Assistant Director of Advocacy at CHIME

CHIME Reacts to Congressional Calls to Suspend Meaningful Use CHIME members voiced their concern this week with congressional proposals to “immediately suspend” EHR incentive payments.  In an Oct. 4 letter to HHS Secretary Kathleen Sebelius, Ways & Means Chairman Dave Camp (R-MI-4), Energy & Commerce Chairman Fred Upton (R-MI-6), Ways & Means Health Subcommittee Chair Wally Herger (R-CA-2) and Energy & Commerce Health Subcommittee Chair Joe Pitts (R-PA-16) voice concern that the incentive payments were being wasted because many providers continue to lack interoperability.  In letters submitted to each of the four Congressmen, CHIME members sought to express their support for both the much needed incentive payments and the policy platform of Meaningful Use.  “While we share 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 letters said. CHIME members in Pennsylvania, California and Michigan also underscored the need for patience.  Stage 2 rules were only finalized in September and are not due to affect eligible hospitals and eligible professionals until 2014.  “While we agree that more standards are needed to enable greater interoperability, Stage 2 final rules contain many of the transport, content and vocabulary standards that vendors and providers need to make true interoperability a reality,” they said.  “Stage 2 will require standards that demonstrate a more capable electronic health record system and a more developed information exchange infrastructure.  Likewise, progress on patient engagement and patient safety will be more visible and widespread because of Meaningful Use Stage 2.”

“As an industry, healthcare CIOs have been working tirelessly for the past two years to meet the requirements of Meaningful Use,” said CHIME Sr. Director of Advocacy Sharon Canner.  “Most hospitals and health systems have invested millions to adopt and meaningfully use EHRs; and while the incentive payments will not cover the costs of implementation, they are a vital resource.  Some facilities simply would not survive the fundamental changes to healthcare delivery and reimbursement without the incentive payments.”

CHIME will continue to monitor the issue and communicate with leaders in Washington about the importance of the incentive payments.  We will also work with them to identify ways to address ongoing concerns about interoperability and progress.  For letters sent to California Rep. Herger, click here.  And for Pennsylvania’s Rep. Pitts, click here.

New Coalition Emerges to Support Nationwide Health Information Exchange A coalition of 15 states, 37 technology vendors and 34 health information exchanges announced this week a program that will test and certify electronic health records and other health information technology for reliable transfer of data within and across organizations and states.  It is the goal that this effort will build on and accelerate consensus on national standards, adopting EHR certification criteria and testing procedures as relevant and finalized for Stage 2 of meaningful use.  The program is led by the EHR/HIE Interoperability Workgroup and Healtheway.  Healtheway is the non-profit organization chartered to support the former Nationwide Health Information Network Exchange that was under the jurisdiction of ONC.  The NHIN Exchange is now the national eHealth Exchange.  The Certification Commission for Health Information Technology (CCHIT) will be the testing and certifying body for eHealth Exchange.  CCHIT will certify that the interfaces between the HIT and HIEs are consistent across multiple states and systems.  The coalition said it has harmonized a set of functional, technical and test specifications that address the major uses of health information exchange to support coordination of patient care. 

For CHIME members interested in learning more about Healtheways and the eHealth Exchange, there will be an CHIME Advocacy webinar scheduled Nov. 29 with the Interim Executive Director of Healtheway, Mariann Yeager.

Bundled Payment Model Gets Put on Hold A new payment reform designed to transition hospitals and other providers away from fee-for-service reimbursements to lump-sum payments that are centered on episodes of care has been halted, according to media reports this week.  Model 1 bundled payments, being run through the CMS Innovation Center (CMMI) will be put on hold because it had “fewer prospective participants and less diversity than originally anticipated when the model was designed,” CMS officials said.  In the first Model of bundled payments, Medicare would pay the hospital a discounted amount based on the payment rates established under the hospital Inpatient Prospective Payment System, and physicians would be paid separately for their services under the Medicare Physician Fee Schedule.  As a part of the initiative, providers would be able to share in savings that come from better care coordination.  Instead, CMMI says they will focus on Models 2, 3, and 4 which have a mix of reimbursement models and payment settings.  The go live for Model 1 bundled payments was January 1, 2013.

Studies Look at Policies’ Impact on Quality, Safety A pair of unrelated studies published this week looked at different policy levers Medicare is using to improve quality and safety.  One study focused on how electronic health records have impacted quality measures among primary-care doctors in the Hudson Valley region of New York.  The other study analyzed several years of billing data to determine if nonpayment programs through Medicare have incentivized better quality and safety.  The results were mixed.  According to findings reported in the Journal of General Internal Medicine, EHR use was associated with higher scores on four of nine quality measures, including:

·         90.1% of the EHR-using doctors vs. 84.2% of those keeping paper charts did appropriate hemoglobin A1c testing for diabetic patients;

·         78.6% of EHR-users vs. 74.2% of paper users met quality measures for breast cancer screening.

·         65.8% to 53% EHRs vs. paper for proper Chlamydia screening and

·         For colorectal cancer screening, it was EHR-using docs 51.3% and paper-using docs 48%

The story on payment reform methods used by Medicare was not as bright.  In October 2008, CMS discontinued additional payments for certain hospital-acquired conditions that were deemed preventable.  Authors of the New England Journal of Medicine study wanted to see if this nonpayment had any effect on the prevalence of two healthcare-associated infections, central catheter-associated bloodstream infections and catheter-associated urinary tract infections.  After using data spanning from 2008 to 2011 at 398 hospitals, the study found “no evidence that the 2008 CMS policy to reduce payments for [such infections] had any measurable effect on infection rates in U.S. hospitals.”  The authors note that “With attention already focused on preventing healthcare-associated infections, the incremental effect of adjusting payment may have been limited.”

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