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Washington Debrief: Burwell Confirms HHS Commitment to Innovation

September 15, 2014
by Jeff Smith, Vice President of Public Policy at CHIME
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Top News

ONC Publishes Final Rule for Next Version of Certified EHRs

Key Takeaway:  The Office of the National Coordinator for Health IT (ONC) released a final rule last week, defining the certification criteria for a voluntary update to 2014 Edition Certified EHR Technology (CEHRT).

Why it Matters: ONC’s 2014 Edition Release 2 remains a voluntary upgrade for providers and is narrower in scope than the proposed rule.  The agency also heeded industry advice, shelving proposals to create new “certification packages,” a new “non-MU certification track” and other ancillary provisions. The update maintained a provision to separate content and transport certification criteria for “Transitions of Care” – a move many believe will enhance information exchange.

According to a new rule published by ONC last week, the “2014 Edition Release 2” adopted ten optional 2014 Edition EHR certification criteria and two revised 2014 Edition EHR certification criteria that will “provide flexibility, clarity, and enhance health information exchange.”  The rule is part of an ONC strategy to make updates, provide “bug fixes” and foreshadow technology upgrades for future Editions.  ONC scaled back several provisions of the proposed rule, including a provision to create a non-MU track of certification and groupings of certification criteria called “certification packages.”  The rule also reemphasized the voluntary nature of this Release, noting “that EHR technology developers do not have to update and recertify their products to the 2014 Edition Release 2, nor do participating hospitals, physicians and other eligible professionals have to upgrade their existing 2014 Edition software to Release 2.”  Rather, it asks that participants merely consider whether Release 2 “offers any opportunities they might want to pursue.”

Observers anticipate a required update to CEHRT sometime this winter when CMS releases its proposal for Meaningful Use Stage 3.

Legislation & Politics

Burwell Confirms HHS Commitment to Innovation

Key Takeaway: Appearing before the Energy & Commerce Committee’s bipartisan 21st Century Cures Initiative, Health and Human Services (HHS) Secretary Sylvia Mathews Burwell confirmed the Department’s commitment to work with Congress to encourage innovation within the nation’s healthcare system.

Why It Matters: HHS Secretary Sylvia Mathews Burwell delivered opening remarks before the 21st Century Cures Initiative’s final roundtable in Washington, DC prior to the November elections. The 21st Century Cures Initiative has heard from thought leaders throughout the healthcare industry as the Committee seeks to identify legislative solutions that encourage advances in medical technology and while identifying government rules and regulations that might currently impede innovation in healthcare.

This summer, the Cures Initiative published a whitepaper and hosted a hearing entitled, "21st Century Technology for 21st Century Cures." Interoperability was among the many issues discussed during the hearing. Lawmakers expressed interest in cost barriers to health IT adoption and interoperability, and panelists agreed on the need for the right payment models and standards to drive the development of interoperable systems. CHIME submitted comments to the 21st Century Cures digital health-focused whitepaper on July 21.

Energy & Commerce Committee Chairman Fred Upton (R-MI) reinforced his intention to have draft legislation resulting from the roundtables by the end of 2014. Chairman Upton has inferred that the legislation could include statutory limits on FDA’s ability to regulate health IT, the creation of a proposed health IT Patient Safety Center, and telemedicine-focused policy changes. Chairman Upton said he expects the legislation to be considered for passage early in the 114th Congress.

Congressman Requests Oversight Committee Hearing on CHS Breach

Key Takeaway: The top Democrat on the House Oversight and Government Reform Committee has requested an investigative hearing concerning the data breach at Community Health Services (CHS), signaling continued Congressional interest in the status of cybersecurity in healthcare.

Why It Matters: Last week, in response to the breach of 4.5 million patient records at (CHS), Rep. Elijah Cummings (R-MD), Ranking Member of the House Oversight and Government Reform Committee requested a hearing to examine the causes and effects of the data breach.

Rep. Cummings acknowledged that cybersecurity threats are an ongoing challenge for both the federal government and the private sector. Further, Rep. Cummings suggested that an investigation of the data security breach at CHS will help the Committee learn from about security vulnerabilities experienced by CHS in order to better protect our federal information technology assets. To date, the hearing has not been scheduled.

State Watch

ATA Grades States’ Telemedicine Policies

Key Takeaway: Last week telemedicine was a topic of interest in the news yet again. Two reports from the American Telemedicine Association (ATA) gave states grads on coverage and reimbursement as well as physician practice standards and licensure.

Why It Matters: Many states still have a lot of work to do to improve telemedicine policies. Telemedicine could improve access to care and lower costs for patients across the country.

ATA used 13 indicators to evaluate each state’s Coverage and reimbursement (http://www.americantelemed.org/docs/default-source/policy/50-state-telemedicine-gaps-analysis---coverage-and-reimbursement.pdf?sfvrsn=6) policies. 7 states received an A, 21 states plus the District of Columbia received a B, 19 received a C and 3 received an F. The top graded states were: Maryland, Maine, Mississippi, New Hampshire, New Mexico, Tennessee and Virginia.  29 states failed when it came to evaluating telemedicine parity laws, equal reimbursement for telemedicine and in-person visits. Meanwhile, state Medicaid agencies seem to be making progress with telemedicine as 47 states have some kind of telemedicine coverage, but many proved to still have barriers to telemedicine services and reimbursement. Connecticut, Iowa and Rhode Island were given failing scores due to their lack of Medicaid, private or state health plan coverage for telemedicine among other things.

For the Physician Practice Standards & Licensure (http://www.americantelemed.org/docs/default-source/policy/50-state-telemedicine-gaps-analysis--physician-practice-standards-licensure.pdf?sfvrsn=6) report, ATA analyzed state laws and decades of research. 23 states and the District of Columbia received an A, 26 states received a B, and 1 received a C in this area. 27 states and DC ranked high in physician-patient encounters. Others scored low due to the fact that they do not allow telemedicine visits to replace in-person visits. These states are: Alabama, Arkansas, Missouri, Nebraska and Texas. Unfortunately, no state achieved the top score, an A grade, for their licensure policies as this continues to be a hurdle to practicing telemedicine within a state and across state lines.

Don’t expect telemedicine to fall from the spotlight anytime soon, either. As you may remember, two bills have been introduced in the House and Senate over the last few months, In July, Reps. Mike Thompson (CA-5-D) and Gregg Harper (MS-3-R) introduced the Medicare Telehealth Parity Act (http://mikethompson.house.gov/newsroom/press-releases/reps-mike-thompson-gregg-harper-introduce-bipartisan-legislation-to-expand) and Sens. Thad Cochran (MS-R) and Roger Wicker (MS-R) filed the Telehealth Enhancement Act of 2014 (http://www.cochran.senate.gov/public/index.cfm/2014/7/cochran-wicker-introduce-telehealth-legislation). A new telemedicine bill related to accountable care organizations is expected soon as well.

Edited by Gabriel Perna for style

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