For the September issue of Healthcare Informatics, and posted online last month, Associate Editor Rajiv Leventhal spoke with various health IT policy experts and leaders to get a gauge on how medical professionals are dealing with the snowball effect of federal mandates that are hitting the industry.
Due to the wide-ranging topic areas that were discussed, much of the content from those conversations was not able to fit online or in print. That’s why, today, HCI is bringing you an extended look at what some of the most prominent health IT policy experts are thinking about in today’s exciting, always-changing healthcare landscape. Involved in these separate interviews are: Russell P. Branzell, president and CEO for the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME); Jeff Smith, senior director of federal affairs for CHIME; Randy McCleese, CHIME’s board chairman and CIO of the Morehead, Ky. St. Claire Regional Medical Center; and Anita Samarth, CEO and co-founder of the Washington D.C.-based consulting firm Clinovations Government Solutions. Below are excerpts from those conversations.
First off, when will we see a long-term Sustainable Growth Rate (SGR) fix?
Smith: I would like to be an optimist on this point, but I can’t with this one. I don’t think there will be a long- term fix until Congress feels the pain of inaction. Up until this point, no Congressman or Senator has not been reelected because of the way they have mishandled payment of physicians in this country. I think the fix we were looking at earlier in the year was hands down the best opportunity that we have had in the nation to change the conversation on how to reimburse. It was nothing short of a lost opportunity. Now, I don’t see that level of momentum building again in the near term unless something unforeseeable happens.
So what are the most pressing regulatory priorities on everyone’s mind right now?
Smith: There is meaningful use (MU), of course, and accountable care organization (ACO) regulations, as it’s been a couple of years in terms of the Centers for Medicare & Medicaid Services (CMS) trying to manage the Medicare Shared Savings program. They will make some tweaks to the path they laid out as I understand it. I wouldn’t expect anything too dramatic, but hopefully it will make the prospects of entering into an ACO agreement a little more incentivizing. But other issues boiling just below surface are patient safety and cyber security. While these issues have not been too big of a focus in healthcare yet, it’s something we will be watching very closely moving forward. As you stand up and start digitizing healthcare, you have to be very cognizant of the fact that there are bad actors out there. And thus, you have to figure out what the proper role is for the government.
Russ Branzell: Trends will be moving—things related to the Affordable Care Act, healthcare reform [more broadly], at-risk contracting, population health, ACOs, and how to position organizations to enable and facilitate those changes. CIOs are playing a unique game of chess right now, deciding how to get ready for this while we’re still trying to support a traditional fee-for-service environment for the majority of the country. It’s almost as if you’re preserving your current biz model while creating and enabling a new business model on the side. The analogy of chess is as good as any out there. We’re not playing traditional fee-for-service checkers anymore.
Anita Samarth: There are regulatory and ICD-10 challenges, and implementation challenges, and the impact of these varies on the organization’s type and size. Large health systems in particular are burdened by the fact that something might not be a difficult thing to do at one of the organizations, but they are still responsible for doing these things consistently across eight or nine hospitals. You might have the infrastructure to achieve them, but there becomes a time crunch. In addition, for a lot of regulatory programs coming out that are performance measurement oriented, you have different people in different measurement years. It all ties back to the burden of the amount of resources and tools you need in house to track what you’re able to report for whom and where, as well as what year you’re in. Monies and incentives are going down.
Has it all become too much of a burden on provider organizations?
Branzell: When you put everything together, the phrase “asking people to do more with less” couldn’t really be any more apt.
Randy McCleese: Let’s put it this way. We have been [going] all out for three years getting everything in place, and now folks are getting tired. They’re saying they don’t want to do all of this anymore, and that it’s getting to be way too much. We recently had a 60-year old surgeon who said, ‘Frankly, I don’t want to do this, I’m going to retire.’ We anticipated him with us for six or seven more years. It’s a loss, and the question is, are we pushing people like that out of the business?
Will it get easier anytime soon?
Smith: I really don’t think it will get easier. We’re in an adolescent stage, maybe not even quite to adolescence when it comes to the business of regulating health IT. We have come a long way in five years—regulators have gotten smarter, the industry has gotten smarter, and conversations on how to move forward on certain subjects have gotten more mature. But I think there is always a danger in piling on. The health IT policy committee has issued recommendations, but it has not been received with great fanfare. Money has run out, and while I agree that Medicare should not reimburse 100 cents on the dollar if providers are not operating at the top of their game, Stage 2 has created a whole litany of sometimes helpful, sometimes hurtful problems that seems to have crossed the line.
Samarth: No, the issues are compounding. There is a fun graphic I use that involves different reporting needs for people in different years of meaningful use, different reporting for different ACOs, different reporting for different payers, reporting for your state and local public health departments, and you have national reporting and reporting for specific registries. That’s just off the top of my head. Are we seeing fewer measures? No, we’re adding, not subtracting. And you’re adding on to your technology, too. You have to add a portal for Stage 2, and there are requirements for public health and for interoperability, which is coming. For now, the burden is still being applied to the provider.
Regarding MU, how heavy of a weight has that mandate been?
[Note: These interviews were done prior to the Aug. 29 announcement that eligible healthcare providers would not be granted the opportunity to engage in a 90-day meaningful use reporting period for second-year reporting, but instead, would be required to engage in a 365-day reporting period in second-year Stage 2 reporting in 2015, whose fiscal year begins October 1, 2014].
McCleese: From a CHIME standpoint, I have been in those regulatory meetings, and the questions we have been asked makes you think that they don’t comprehend the magnitude and complexity of systems, upgrades and changes that have to go on. We’re looking at that proposed flexibility as too little, too late. Had that been something that had been finalized especially in May or June, we could have had the attitude that this is a final rule now and we can really live by it. In the middle of an attestation period, you can’t just change.
Branzell: MU, at the macro level, is still correct and still the right thing to do. We need it to head down the path we want to go on. Our concern is that when the appropriate course corrections come, it is usually too late. It’s a reaction to failure rather than a reaction to enable success. We were pleading for this flexibility almost a year ago.
The two fundamental issues with MU are transitions of care and patient portals. If you’re just getting software portals, like many people we talk to are, how are you going collect enough data, never mind get enough people signed up for it to meet the percentage of people you need using it? As far as transitions of care, so many organizations that you’re partners with aren’t ready either.
Samarth: A problem is that when larger health systems are upgrading products, it’s not just about MU. There is an opportunity to optimize; you can’t just run out an MU-specific update or change. Let’s say they got their product certified early this year and roll it out over three-six months. Then the client wants to put it in their staging environment, before their production environment. Adding that up, you get to October quickly.