Now that key leaders at two major federal healthcare agencies have been confirmed to their posts—Health & Human Services (HHS) Secretary Tom Price, M.D., Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, and John Fleming, M.D., deputy assistant secretary for health technology (a new position created at HHS)—various health IT leaders have turned their attention to working with the departments on their core priorities for the industry. And while healthcare trade association groups have done just that in recent days, they are still very much in wait-and-see mode as Price, Verma and Fleming settle into their new leadership roles.
Certainly, the new federal officials have a lot on their plates and will need time to get up-to-speed and briefed; Verma, for one, was confirmed just two weeks ago, and Fleming just days ago. Also, the recent focus of President Trump, from a healthcare standpoint, had been on the attempt to repeal the Affordable Care Act (ACA), but now it seems that with the recent developments on Capitol Hill, the administration will be moving onto other priorities.
Prior to last week’s news of the ACA repeal failure, there had been legitimate questions as to whether or not Trump’s attention on the repeal was pushing other delivery system reform efforts to the back of the line. In a recent interview with Healthcare Informatics, Leslie Krigstein, vice president for congressional affairs at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), indeed hinted this was the case. Krigstein said,”…Just the fact that they’re still getting staffed up is why we haven’t seen that much activity; and also the fact that they had all hands on deck for the ACA effort that’s now ended.”
As such, Krigstein noted in that interview that Price, Verma and others could act quickly now that the ACA repeal is no longer a core emphasis of the administration. She said, “Yes, I think we’ll see some fairly swift action, and maybe around IPPS [the Inpatient Prospective Payment System payment rule] and MACRA [the Medicare Access and CHIP Reauthorization Act of 2015].”
Meanwhile, CHIME has offered its support for Price and Verma as they ease into HHS and CMS. In a separate interview from the aforementioned one, Krigstein says that as an organization, CHIME has worked closely with Price in the past when he was a member of the House. She notes that he co-sponsored a few different meaningful use-related bills, signed a few health IT-related letters, and asked a lot of questions during Congressional hearings on MACRA. “We feel comfortable with his track record, [given] the health IT and meaningful use issues from a provider perspective,” Krigstein says. “He’s been sympathetic to the need for flexibility and rethinking of the meaningful use program. So from that standpoint, we were pleased to see him confirmed. And now that he is on the administration, we’re looking forward to see some of those efforts from Congress carry over into his new capacity of HHS Secretary.”
Verma, on the other hand, is a lesser known figure to health IT folks. But as Mari Savickis, vice president, federal affairs at CHIME, says, the remarks she made during her Senate confirmation hearings on the need for EHR [electronic health record] efficiencies lead to reason for optimism “We are looking forward to getting to know her and working with her. We understand there’s a lot going on right now,” Savickis says, suggesting that not everything will happen all at once in 2017.
To this end, Savickis says that the next step is waiting for CMS to put something in the IPPS proposed rule in April, which could include key information regarding the future of the meaningful use program. “We’re banking on that,” Savickis says. “The first major regulatory vehicle that we expect to see has to do with their direction on meaningful use. We might see a delay [to Stage 3] as they might need to recalculate what’s needed for that stage, and that’s ok, too. When you walk into a new administration, there’s a lot to deal with, there are new people, so if you don’t get everything you want this year, that doesn’t necessarily mean you are getting a lump of coal.”
Nonetheless, Savickis further says that a robust conversation is needed about aligning MIPS (the Merit-Based Incentive Payment System) on the clinician side with the hospital side, as currently, MIPS reporting does not impact hospitals. “That’s a conversation worth having,” she says. “We also do not have the new advisory committee that was created in the 21st Century Cures Act, which will begin this summer. So they have to time their footing; there are a lot of pieces,” she adds.
Overall, health IT leaders seem bullish that Price is a physician leader and understanding of the issues that doctors around the country are having with EHRs. “[He] has been a champion for leveraging health IT in smart ways and reducing some of the regulatory requirements of recent years,” Savickis says. “We do need to tackle Stage 3 and the 90-day reporting period [for all reporting programs], and tackle the fact that most of our members are without a 2015 certified EHR. Things are coming at us quickly in 2017. But we are cautiously optimistic that the new administration has heard us, even though we understand Seema has not been on the scene long,” she says.
Telehealth Gaining Traction
Further, regarding health IT priorities for the new administration, Thomas (T.J.) Ferrante, a Tampa, Fla.-based associate and healthcare lawyer with Foley & Lardner LLP, notes that there has been recent momentum around telehealth legislation that has gotten bipartisan support on the Hill. Ferrante points to Congress enacting both the Expanding Capacity for Health Outcomes (ECHO) Act and the 21st Century Cures Act last year. “These bills signal telehealth's broad appeal as a uniquely bipartisan solution in an increasingly divided policy landscape,” he says, adding that several U.S. senators have already reached out to Price touting telehealth’s benefits. “I believe these efforts signal there may be more significant governmental support for the adoption and reimbursement of telehealth practices in the near future,” he says. Interestingly, however, Ferrante adds that while the Cures Act includes a directive from Congress for further study into the use of technology for the delivery of healthcare services, “some may argue that asking for a study instead of taking real action is merely punting on the issue.”
But overall, Ferrante feels that CMS sometimes is unfairly criticized because people “demand” the agency change the Medicare telehealth coverage rules and allow reimbursement for patients in urban areas as well as rural. “But, these restrictions we imposed by Congress, contained in the Social Security Act, and CMS cannot override federal statutes. In fact, CMS has made many outreach efforts to eliminate artificial restrictions and promote the meaningful use of telemedicine in healthcare delivery, and they should be recognized for that vision and those efforts.” He adds that CMS has historically been slow-moving in how it approves new telehealth services, as for 2017, the agency approved three new telehealth services but turned down requests for several others.
Indeed, both Price and Verma have expressed positive sentiments about telehealth in recent hearings. In one Senate hearing, Verma said, “Telehealth can provide innovative means of making healthcare more flexible and patient-centric. Innovation within the telehealth space could help to expand access within rural and underserved areas.” Meanwhile, Price called telehealth “vital,” and said it is an exciting innovation.
Moving forward, Ferrante notes that CMS could begin to implement the findings in its previous studies and allow for expansion for those telehealth services that have proven to enhance quality and reduce costs in specific population groups. “The inclusion of telehealth in value-based payment models can help assess the value of telehealth in situations where financial incentives promote quality improvement and cost savings. Areas ripe with opportunity for this would be telestroke and remote patient monitoring,” he says. Overall, when asked how federal leaders could take action, Ferrante recommends, “Loosening some reimbursement and regulatory requirements on the federal side would drive telehealth growth, adoption, and innovation in the marketplace ultimately helping patients receive the right care, at the right place, at the right time.”