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Washington Debrief: Congress Passes 2-Year Budget, Healthcare Prime Target for Budget Cuts

November 2, 2015
by Leslie Kriegstein, Interim Vice President of Public Policy, CHIME
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Congressional Affairs

Congress Passes 2-Year Budget, Healthcare Prime Target for Budget Cuts

Key Takeaway: Congress last week passed a two-year budget deal that raises funding levels and suspends the debt limit until 2017.

Why It Matters: Uncertainty year-over-year about budget levels has caused frustration, both among agency officials and lawmakers alike. However, the healthcare sector was heavily targeted to generate the funding to offset other budget increases across the federal government.

The bipartisan budget passed by the House and Senate last week used a number of hospital-focused programs to generate the savings needed to increase funding levels for agencies including National Institutes for Health (NIH) and National Science Foundation (NSF). The budget includes a 2-percent cut in Medicare provider payments. Further, the budget deal cuts funding for healthcare services provided in a hospital’s outpatient department or “site neutral” payments.

Leslie Kriegstein

Behavioral Health Hearing Highlights Importance of Interoperability, HIPAA Confusion

Key Takeaway: The Senate Health, Education, Labor and Pensions Committee (HELP) held a hearing last week evaluating challenges, opportunities and priorities in mental health and substance abuse. The importance of information sharing and telemedicine were highlighted.

Why It Matters: Members of Congress have recognized that high functioning EHRs and robust health data exchange are imperative to improve care for all patients across the healthcare delivery spectrum, including substance abuse and mental health treatment.

Despite the calls for increased data exchange, the HELP committee members questioned the role HIPAA may play in stirring confusion and hesitancy among providers to share mental health or substance abuse treatment information.

Senators Bill Cassidy (R-LA) and Chris Murphy (D- CT), who introduced the Mental Health Reform Act of 2015 (S.1945), penned an op-ed last week to outline the intent of their bill and the criticality of mental health reform. “We also address the need for families to have medical information. A lack of understanding and consistent misinterpretations of the Health Insurance Portability and Accountability Act (HIPPA). HIPAA’s privacy rules have created barriers for parents and caregivers to be included in the care plan with families caring for the seriously mentally ill experiencing the worst impact,” they wrote.

The committee Chairman Lamar Alexander (R-TN) announced additional hearings were forthcoming and indicated the committee would work on a mental health bill next year.

House Members Question VA and DOD Decision to Develop Separate EHR System

Key Takeaway: The chairman of the Oversight and Investigations Subcommittee of the House Committee on Veterans’ Affairs indicated his willingness to cut funding for the Department of Defense (DOD) and Department of Veteran’s Affairs (VA) if the agencies neglect to comply with an ongoing congressional investigation into the efforts to develop separate EHR systems to serve active duty and retired military personnel.

Why It Matters: Lawmakers’ frustration comes on the heels of the $9 billion contract, known as the Defense Healthcare Management Systems Modernization (DHMSM) program, which will replace EHRs at 1,230 DoD sites worldwide.

Rep. Mike Coffman (R-CO), chairman of the House Veterans Subcommittee on Oversight and Investigations felt that the 2013 decision to stop working on a single, joint EHR after spending more than four years and $500 million on the project has not been properly justified to date.

Members from both sides of the aisle expressed their frustration with the situation during a hearing. Rep. Tammy Duckworth (D-IL), a veteran, cited a consistent unwillingness on behalf of DOD to work with the VA to modernize the Veterans Health Information Systems and Technology Architecture, or VistA. The committee heard testimony from representatives of the VA, DOD and Government Accountability Office.

Both agencies are currently making major changes to their EHR systems by adopting private-sector technology solutions. The committee members requested that the VA and the DOD submit a cost analysis that compares their decision to build separate EHR systems with estimated costs for a joint system.

Paul Ryan Elected Speaker of the House

Key Takeaway: The House elected Congressman Paul Ryan (R-WI), former vice presidential candidate, to be the next Speaker of the House, replacing outgoing leader John Boehner (R-OH).

Why It Matters: Ryan was most recently the chairman of the Ways and Means Committee, which has substantial jurisdiction over healthcare issues. Ryan has been very focused on Medicare reform. Previously, he proposed a plan to convert Medicare into a system of subsidies for seniors to buy coverage from private insurers, or a watered down version of the current program.

Federal Affairs

2016 PQRS Negative Payment Adjustment and the Informal Review Process

Key Takeaway: All informal Physician Quality Reporting System (PQRS) review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which will be available through November 9, 2015, at 11:59 p.m. EST.

Why it Matters: In 2016, CMS will apply a negative payment adjustment to individual eligible professionals (EPs), comprehensive primary care (CPC) practice sites, and group practices participating in the Physician Quality Reporting System (PQRS) group practice reporting option (GPRO) (including Accountable Care Organizations [ACOs]) that did not satisfy reporting requirements in 2014. Individuals and groups that receive the 2016 negative payment adjustment will not receive a 2014 PQRS incentive payment.

EPs, CPC practice sites, PQRS group practices, and ACOs that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment may submit an informal review between Sept. 9, 2015, and Nov. 9, 2015, requesting CMS investigate incentive eligibility and/or payment adjustment determination. All informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review.

Please see 2014 PQRS: Incentive Eligibility & 2016 Negative Payment Adjustment - Informal Review Made Simple (available on the Analysis and Payment section of the PQRS website) for more information. For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information, such as Social Security Number or Taxpayer Identification Number (TIN), in e-mail inquiries to the QualityNet Help Desk.


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