Cures Bill Addresses Interoperability, Information Blocking and Threatens Decertification
Key Takeaway: A bill that would establish new criteria for interoperability cleared the first hurdle toward passage last week, as the 21st Century Cures initiative was unanimously approved by the Energy & Commerce Health Subcommittee.
Why it Matters: The proposed legislation contains a number of provision relative to interoperability that could impact the existing business and clinical practices employed within care settings with the intention of increasing access to patient health data.
The provision championed by Representative Michael Burgess (R-TX-26), would set new criteria for interoperability: “Secure Transfer,” “Complete Access to Health Data” and “No Information Blocking.” Further, it would establish a new organization under the leadership of the National Committee on Vital Health Statistics (NVCHS) that would identify “methods” and metrics by which products would be certified as interoperable or not-interoperable.
In 2018, the Secretary of the Deparment of Health and Human Services (HHS) would publish a list of vendors in compliance and those not in compliance with the “methods” relative to interoperability and by 2019, vendors can be decertified. If a provider’s product becomes decertified, they can apply for a hardship exemption for up to five years to avoid penalties under the meaningful use program.
The bill seeks to combat the practices of information blocking, by enforcing civil and monetary penalties on providers, hospitals, health information system providers and vendors who have been found to partake in information blocking practices. The bill outlines the criteria for information blocking as below:
- Interfere with the exchange of electronic health information;
- The actor knows or should know is likely to interfere with the exchange or use of electronic health information; and,
- Do not serve to protect patient safety, maintain the privacy and security of individuals’ health information or promote competition and consumer welfare.
The bill largely avoids changes to the meaningful use program and neglects to acknowledge the ongoing challenge to data exchange posed by the lack of a national patient identification strategy.
The legislation is still under development, as Committee staff seek to incorporate stakeholder input on the items proposed. The legislation was approved the Health Subcommittee on May 14th and is likely to be approved by the full Energy & Commerce Committee this week. Chairman Fred Upton (R-MI-6) has indicated that the bill could pass the House this summer.
HHS’ ICD-10 Preparedness Subject of New House Bill
Key Takeaway: Policymakers continue to question the readiness of the Department of Health and Human Services’ (HHS) readiness to process ICD-10 claims beginning on October 1, 2015.
Why it Matters: The legislation introduced by Representative Diane Black (R-TN-6) would require HHS to conduct comprehensive, end-to-end testing to declare to Congress their readiness to accept ICD-10 claims. The legislation wouldn’t change the October implementation date for ICD-10.
The ICD-TEN Act does not delay implementation, but proposes an 18 month safe harbor for the inaccurate reporting of sub codes. HHS is given 18 months from October 1, 2015 to declare whether the system is fully functional, which is defined as the volume of claims accepted under ICD-10 is equal to or greater than, the percentage of claims accepted under ICD-9 codes during the previous calendar year.
Federal Advisors Recommend Changes to Proposed MU Rules
Key Takeaway: Members of the Health IT Policy and Standards Committees reviewed proposals for Stage 3 meaningful use last week, issuing a bevy of recommended changes. Generally, requirements for care coordination through patient engagement and health information exchange were considered to be too difficult as proposed.
Why it Matters: Seeing that federal advisors are more aligned with discussions outside Washington, DC is a promising sign that positive changes can be made to Stage 3 requirements. CHIME and AMDIS will soon publish comments of its own to help members form their own opinions.
During the May meeting of the Health IT Policy Committee, members of the Interoperability and Health Information Exchange Workgroup offered thoughts on the health information exchange requirements for Stage 3. Workgroup members agreed that thresholds for sending electronic summary of care records during transitions of care or referrals and for incorporating such records for new patients were too high. The workgroup called the thresholds “unrealistically high,” saying they did not want to “have to backtrack on the threshold, as has happened with VDT,” and that they agreed with motiving providers to “own the problem,” but they did not want to penalize providers for factors that are genuinely out of their control.
Members of the Consumer Workgroup were more bullish in their assessment of patient engagement and care coordination measures. The workgroup issued recommendations that would make requirements for Objective 6: Care Coordination through Patient Engagement stricter. The workgroup, which is composed of 21 members, but only 1 provider who would be responsible for implementing the recommendations, recommended CMS finalize a rule where “All three measures are required, but the threshold for the VDT measure is reduced from 25% to 10% and the PGHD measure is revised:
- Measure 1: 10 percent of patients view, download or transmit their health info through portal or API
- Measure 2: As proposed, a secure message was sent to more than 35 percent of all unique patients (or the patient's authorized representatives) using the electronic messaging function of CEHRT or in response to a secure message sent by the patient (or the patient's authorized representative).
- Measure 3: Modification: Patient-generated health data is incorporated into the certified EHR technology for more than 10 percent of all unique patients. The modification is: moving “or data from a non-clinical setting” to the HIE objective.”
CHIME and AMDIS will be finalizing comments this week for public distribution. The comment deadline for Stage 3 comments is May 29, 2015.
Edited by Gabriel Perna for style