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D.C. Report: Looking Ahead to the Fiscal Cliff, Stage 3 Meaningful Use

November 12, 2012
by Jeff Smith, Assistant Director of Advocacy at CHIME
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Jeff Smith, Assistant Director of Advocacy at CHIME

As Elections End, Congress Turns to Fiscal Cliff Following the "silly season" of presidential election year politics; the nation took a collective breath to assess what had happened: The House is still controlled by Republicans; the Senate still in the hands of Democrats and President Obama still resides at 1600 Pennsylvania Avenue.

Of course, this generalization hardly tells the whole story.  There are many new faces in Congress - many due to retirements and others due to lost re-election bids - especially on key committees related to healthcare.  Membership changes on Ways & Means, Energy & Commerce and the Senate Health, Education, Labor & Pensions committees will likely impact their respective approach to healthcare issues.  The chairman and ranking member of the Ways & Means subcommittee on health will not return in the next Congress; four members of the Energy & Commerce health panel are leaving and one member from the Senate HELP subcommittee on Primary Health and Aging will not be back.  Despite these changes in personnel, many observers believe that Republican leaders will continue efforts to delay, change and repeal aspects of the Affordable Care Act.  But because the Senate and White House remain Democratic, these efforts are not likely to succeed in full.

While the power dynamics will appear similar in the 113th Congress as it did in the 112th Congress, the environment in which the new Congress operates looks entirely different.  Sequestration and other fragments of the "fiscal cliff" must be dealt with over the next several weeks and it would seem probable that Republicans look to use parts of the ACA as bargaining chips to get the bigger deal done.  Even if the big deal isn't done - to negate sequestration, fix the sustainable growth rate and avoid broad tax increases - enough money is at stake ($668 Billion) that some kind of deal is done to narrowly avoid catastrophe.  It is likely through some minimal bill that tweaks are made to ACA implementation, particularly Medicaid and insurance provisions.  In comments made during a Washington event this week, former Senate Majority Leader Tom Daschle said that, "virtually everything in HHS," is going to be under the budgetary knife. "I don't think there's any question that discretionary accounts are all going to be adversely affected-that's a given," Daschle said. "I can't predict precisely what it will mean. But if I had to guess, I'd say it's going to be a 10% haircut at least, and I would say almost categorically that's going to affect almost every program."

Health Policy Committee Looks Towards MU Stage 3  While much of the industry continues its march towards Meaningful Use Stage 1 (just over 25 percent of the nation's hospitals have attested to Medicare Meaningful Use at this point) others are busy studying final regulations for Stage 2, due to launch in 2014.  Still others have 2016 on their minds - the year Meaningful Use Stage 3 is scheduled to kick in.  This week the Health IT Policy Committee released a draft version of their request for comment (RFC) regarding Stage 3. According to the RFC, the committee is looking to set a bar for stage 3 that: supports new models of care coordination; promote medical advancement and innovation; be achievable and reflect the feasibility of EHR products. Broadly the committee wants to use national health priorities, such as heart disease, diabetes and other chronic conditions as a guide on priorities.

During deliberations held this week in Washington, members of the HITPC focused extensively on clinical decision support (CDS) and mused on that functionality's potential to be a true force multiplier in improving care and reducing costs.  The committee also said that it hopes "Stage 3 is the time to begin to transition from a setting-specific focus to a collaborative, patient- and family- centric approach."  The RFC is due out before Thanksgiving with an anticipated 45-day comment period. Stemming from those responses, the HITPC is looking to have final recommendations to HHS in May 2013.

Providers Get Extension for E-Prescribing Hardship Exemptions Providers faced a 1.5 percent reduction in Medicare claims in 2013 if they did not submit ten electronic prescriptions by June 30, 2012 under the e-prescribing program, which is working to set the physician fee schedule for 2013.  Originally, they had until June 30 to file a hardship exemption by that same June 30 deadline to prevent this reduction in payments.  According to media reports, "the e-prescribing program allowed health care providers to file for hardship exemptions if they:
 

  •        Were unable to e-prescribe because of certain laws or regulations;
  •        Generated fewer than 100 prescriptions during a six-month reporting period;
  •        Practice in an area that has a limited number of pharmacies with e-prescribing capabilities;
  •        Prescribe large volumes of narcotics; or
  •        Work in a rural area that has limited access to high-speed Internet."

CMS proposed two new extensions - eligible providers or groups participating in meaningful use are now eligible for the exemption to prevent them from having to implement a separate e-prescribing module while implementing an EHR based on conflicting different deadlines for the two programs.  E-prescribing is not available until an EHR has been fully implemented, thus if a provider chose an attestation period later in 2012, they would have missed the deadline to submit ten e-prescriptions by June 30, 2012.  The new deadline for filing a hardship extension is January 31, 2013. Read more about the exemptions here.

Study: Patient Centered Medical Homes on the Rise Half of the nation has implemented new payment changes to expand access to patient-centered medical homes in Medicaid or the State Children's Health Insurance Program, a report in Health Affairs found.  The initiatives vary widely, according to the report. For example, 12 states include multiple public and private payers; 19 pay providers a monthly care management fee in addition to the standard fee-for-service payment; 14 provide performance-based payments; and five provide payments to support up-front costs. Although no state has implemented global payments that hold a group of providers at financial risk for the care that patients receive in a given time period, five states are using their experience with medical home initiatives to move toward accountable care payment models, the study notes. The medical home model uses care teams led by primary care providers to coordinate and integrate care for chronically ill and other patient populations in an effort to improve care and lower costs. 
 


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