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Washington Debrief: How the Republican Election Victories Impact Health IT Reform

November 10, 2014
by Jeff Smith, Vice President of Public Policy at CHIME
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Jeff Smith, Vice President of Public Policy at CHIME

Top News

Republicans Take Control of Senate, Expand Margin in House

Key Takeaway: The Republicans will take over leadership of the Senate and will have an expanded majority in the House when the 114th Congress begins in January. Shifts in committee leadership, especially in the Senate, increase the likelihood that health IT reform legislation will be considered by Congress in 2015. Rumors of a full repeal of the Medicare Sustainable Growth Rate (SGR) and the passage of legislation focused on cyber security and information sharing have increased, even as agenda-setting for the lame duck session has begun.

Why It Matters: With an author of the “REBOOT” report and a long-time health IT champion, Sen. Lamar Alexander (R-TN) and Sen. Orrin Hatch (R-UT), likely to assume the chairmanships of the Senate HELP and Finance committees, respectively, health IT advocates are optimistic about a variety of legislative reforms that could be considered by these two committees.

Sen. Patty Murray (D-WA) probably will assume the HELP Committee Ranking Member slot, while Sen. Ron Wyden (D-OR) is expected to remain the top Democrat on the Finance Committee.

Come January 2015, the Republicans will control the Senate with a minimum of 52 votes, while the number of Republicans in the House increased to 243, up from 233 in the 113th Congress.

In the House, Rep. Fred Upton (R-MI) will remain the Chairman of the House Committee on Energy & Commerce, while Reps. Paul Ryan (R-WI) and Kevin Brady (R-TX) will vie for the top spot on the Ways & Means Committee. Among Democrats competing for the ranking member role on the Energy & Commerce Committee are Reps. Frank Pallone (D-NJ) and Anna Eshoo (D-CA). Eshoo has been endorsed by House Minority Leader Nancy Pelosi (D-CA). Rep. Sander Levin (D-MI) is expected to remain the ranking member on the Ways & Means Committee.

Health IT topics likely to be addressed in the Republican-controlled 114th Congress include: cyber security, the Meaningful Use Program, telemedicine, software regulation, quality measurement and patient safety reporting.

For the remainder of 2014

The current continuing resolution (CR) expires on Dec. 11, 2014; lawmakers will return to Washington with several issues requiring immediate action, including funding the government through Fiscal Year 2015. Recent reports from Republican leadership show an interest in passing an omnibus bill to fund the government through Sept. 30, 2015. Other issues needing attention before the 113th Congress ends are expiring tax breaks, including the popular research and development tax credit, and the extension of terrorism risk insurance.

Discussion around a permanent fix for SGR, the physician Medicare reimbursement approach, has increased among the leaders of health-focused committees. The issue of finding offset savings remains a hurdle to passing a permanent payment solution. Additionally, with top Republicans on the Senate and House Select Intelligence committees set to retire at the end of the 113th Congress, Sen. Saxby Chambliss (R-GA) and Rep. Mike Rogers (R-MI), expectations are rising that there will be additional pressure to pass cyber security information sharing legislation before they leave Capitol Hill.


As 2014 MU Attestations Lag, Healthcare IT Leaders Worry about 2015

Key Takeaway: Centers for Medicare and Medicaid Services (CMS) data released during the November Health IT Policy Committee indicate that 2014 attestations are lagging, compared with 2013. Approximately 1,900 hospitals have attested to either Stage 1 or Stage 2 of Meaningful Use (MU) in 2014, compared with nearly 3,400 in 2013.

Why it Matters: Participation rates released last week validate industry concerns that changes to MU, meant to provide flexibility in 2014, will be greatly muted by providers’ inability to meet more difficult program requirements for a full year in 2015.

CMS figures indicate that approximately 2,560 hospitals were scheduled to meet Stage 2 Meaningful Use in 2014. However, new flexibility from a final rule released on September 4 gave hospitals the ability to repeat Stage 1 if they could not meet Stage 2 requirements, and they could attest to having troubles with 2014 Edition CEHRT implementation. Despite lowered expectations of Stage 2 hospital participation, CMS data released last week show that 840 hospitals have met the Stage 2 bar, over a 90-day reporting period, in 2014; this amounts to less than one-third of hospitals scheduled to meet Stage 2 in 2014, and health IT leaders worry this data paints an ominous picture of the program’s near-term future.

In 2015, nearly 4,000 hospitals are scheduled to meet Stage 2 Meaningful Use requirements for a 365-day reporting period. CHIME and other health IT leaders say this will put senseless stress on program participants and will impede program success, because many hospitals will be unable to achieve the next phase of MU.

“Meaningful Use participation data released have validated the concerns of providers and IT leaders. These numbers continue to underscore the need for a sensible glide path in 2015,” CHIME President and CEO Russell P. Branzell, FCHIME, CHCIO said in a statement. “Providers have struggled in 2014, in many instances for reasons beyond their control. If nothing is done to help them get back on track in 2015, we will continue to see growing dissatisfaction with EHRs and disenchantment with Meaningful Use.”

Various organizations, including the American Medical Association (AMA), the Healthcare Information Management Systems Society (HIMSS) and the Medical Group Management Association (MGMA), have echoed these concerns, calling on the Department of Health and Human Services (HHS) to shorten the reporting period.

Hospitals have until November 30 to attest for 2014, or they can seek a hardship exception, which has the same deadline.

2015 Physician Fee Schedule Adds Telehealth Codes

Key Takeaway: CMS released the final rule for the 2015 Physician Fee Schedule last week, which includes seven new telehealth reimbursement codes for Medicare. The rule also makes changes to quality measure reporting requirements and encourages use of certified EHRs for chronic care management.

Why It Matters: CMS has continued to take steps to modernize Medicare reimbursement through a number of programs including bundled payments and ACOs, and with the addition of seven telemedicine codes under the Physician Fee Schedule, they acknowledge that health IT and telemedicine specifically can help reduce healthcare costs and improve outcomes.

The new codes will cover telehealth consultations and wellness visits, prolonged office visits, tele-psychiatry services and “any additional service specified by the Secretary, when furnished via a telecommunications system.” They will also be able to bill directly for managing patients with two or more chronic conditions, including the use of remote patient monitoring services, which was previously billed by bundling it with E&M codes.

As for quality reporting, the 2014 final rule required that physicians use the most up-to-date certified and tested version of a quality measure, but the 2015 final rule reversed this piece as it is costly and cumbersome to test and recertify an EHR for every quality measure update. But, physicians should note that they will still need to use the most recent version of a quality measure if they are not using the most up-to-date version. The rule also includes a 21% pay cut for physicians if Congress does not take action on the Sustainable Growth Rate by the end of March 2015.

CHIME News & Notes

Key Takeaway: Officials from CHIME and HIMSS sent a letter to HHS Secretary Burwell last week, voicing concern with “leadership transitions” at ONC.

Why it Matters: Stakeholders are still grappling with how recent, high-profile departures at ONC will affect key programs such as Meaningful Use, the Interoperability Roadmap and the Patient Safety Center. Of deeper concern – beyond having leadership slots filled – is whether ONC and health IT will continue to be prioritized by HHS leadership.

Leadership of both CHIME and HIMSS sent a letter to HHS Secretary Burwell last week, urging her to “fill all ONC leadership positions as soon as possible with well-respected leaders who possess a combination of clinical training and practice, clinical and business informatics expertise, a clear vision for IT’s role in enabling healthcare transformation, and experience in public policy.” The two organizations voiced their concern that a “full-time national coordinator must be in place” to meet the pressing challenges facing the industry. Click here to read the full letter.


Edited by Gabriel Perna for style

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