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Washington Debrief: MU2 Deadline Relief Promised, CHIME Leads Effort to Address Concerns

March 3, 2014
by Jeff Smith, Senior Director of Federal Affairs
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Jeff Smith, Senior Director of Federal Affairs

CMS Reacts to Stakeholders’ Meaningful Use Letter, Vows Relief

Key Takeaway: CMS Administrator Marilyn Tavenner, R.N. told HIMSS14 attendees last week that both ICD-10 implementation and meaningful use deadlines remain unchanged. However, her agency promised to perform end-to-end testing for ICD-10, and it plans to make it easier for providers to obtain hardship exceptions if they are not able to meet MU requirements in 2014.

Why it Matters: This announcement reveals, for the first time, how policymakers are looking to mitigate sub-optimal participation in meaningful use during program year 2014. The rule is sufficiently broad to define new areas for hardship exception, but the current application of the rule only permits EHR hardship exceptions for providers whose vendor went bankrupt or is decertified. Additional details are expected from CMS soon.

Next Steps: CHIME will work closely with CMS to ensure the hardship exceptions are established in a fair manner and they address longstanding concerns. CHIME also will seek volunteers to help CMS perform ICD-10 testing.

On Monday, February 24, the first day of HIMSS14, a letter to Secretary Kathleen Sebelius, signed by nearly 50 provider organizations was made public. The letter sought more time and flexibility for providers that are struggling to meet Meaningful Use requirements in 2014. In an attempt to address these concerned – voiced by CHIME, the AHA, the AMA, AHIMA and 44 additional organizations – CMS Administrator Tavenner and National Coordinator Karen DeSalvo, M.D. acknowledged program successes and challenges. Administrator Tavenner remained steadfast on both the ICD-10 deadline (Oct. 1, 2014) and deadlines related to Meaningful Use, saying both were vitally important to broader health reform initiatives. “All of these programs [ICD-10 and MU] use tools to link outcomes, link cost of care, link quality and link payments together,” she said.

However, CMS said it was “cognizant of the concerns expressed by stakeholders regarding availability of 2014 Edition Certified EHR Technology. Therefore, HHS will implement a flexible hardship exception policy so those who legitimately tried to upgrade their EHR product to the 2014 Edition but may have not had time to implement the system would not be penalized in 2015,” the CMS said.

In response, CHIME officials said, “If the expansion of the office’s EHR Hardship Exceptions provides the kind of relief the industry desperately needs, CHIME pledges to assist policymakers in every way possible. Should CMS choose to define the new hardship exceptions in a way that does not address the core concerns of our industry, we will continue to seek the kind of flexibility that nearly 50 national healthcare organizations communicated to HHS Secretary Kathleen Sebelius on February 21, 2014.

Many CHIME members continue to voice concerns over code delivery and implementation challenges related to both ICD-10 and MU. Please contact Jeffery Smith, Senior Director of Federal Affairs, with any questions or comments concerning your facility’s readiness for looming ICD-10 and MU deadlines in 2014.

ONC Proposes New Voluntary EHR Certification Criteria

Key Takeaway: The ONC released its first set of voluntary EHR certification criteria, building on an “Edition” construct first established as part of Stage 2 rules.

Why it Matters: ONC believes this approach, developing a 2015 Edition voluntary certification before a mandatory 2017 Edition, will enable more efficient software development and deployment.

The Office of the National Coordinator published a notice of proposed rulemaking (NPRM) last week, which “marks the first time ONC has proposed an edition of certification criteria separate from the Centers for Medicare & Medicaid Services' meaningful use regulations.” The 2015 Edition certification is voluntary, meaning that EHR developers would not be required to incorporate new criteria – and providers would not have to adopt new technology – to demonstrate Meaningful Use in 2015 or 2016.

The bulk of the certification rule would leave 2014 Edition criteria unchanged, officials noted, and it defines “gap certification,” that would enable developers to use previous certification results to qualify for future certifications. The remainder of the proposed regulation includes:

  • “Bug fixes,” where standards need to be harmonized among disparate programs or updated to enhance interoperability;
  • A path for certification of “non-MU” EHR technology; and
  • Questions that foreshadow 2017 Edition capabilities

For CHIME members interested in learning more, we will be forming a workgroup to better understand and provide feedback on the proposed rule. Interested CHIME members should watch for more details on how to get engaged.

ONC Patient Matching Recommendations: Data Standards Needed

Key Takeaway: ONC released their full patient matching report before HIMSS14. The report calls for data standardization of several patient demographic fields to increase patient matching accuracy and to enable EHRs to have the capability of creating patient matching reports to find duplicate records easily. ONC will not create a standardized algorithm for patient matching.

Why it Matters: The current 2014 edition certification does not include any patient matching recommendations, but the proposed voluntary 2015 edition certification contains some language to standardize demographic data elements.

ONC conducted an environmental scan on patient matching in 2013 in which they reviewed current literature on the subject and interviewed health systems, HIOs, EHR vendors and MDM/MPI/HIE vendors to find best practices. In the 2015 Edition EHRs, ONC is suggesting standardization around “First name, last name, middle name (or middle initial in cases where only it exists/is used), suffix, date of birth, place of birth, maiden name, current address, historical address, phone number and sex.” CHIME will reconvene the patient matching workgroup within the next two weeks to discuss ONC’s patient matching recommendations and the 2015 edition certification proposals related to it. Interested parties should contact Angela Morris.

Congressional Deadline Looms on SGR Fix

Key Takeaway: A key group of legislators have lent support to a “repeal and replace” bill that’s intended to permanently fix the sustainable growth rate formula. The Congressional Budget Office estimates the cost of the bill to be $138 billion from 2014 to 2024.

Why it Matters: Support for a permanent SGR replacement bill, which transitions away from fee-for-service reimbursement for physicians, is gaining momentum, and a CBO score gives lawmakers a tangible cost target to aim towards. Now, the only thing lawmakers need is time – on March 31, reimbursement rates are scheduled to drop by more than 24 percent.

Last week, two key developments towards a permanent fix to the Medicare physician payment system played out: The GOP Doctors Caucus publicly lent support to the bicameral, bipartisan plan, and the CBO said such a deal would cost $138 billion over 10 years. The GOP Doctors Caucus had been reluctant to support the bill for a number of reasons, including a 0.5 percent payment increase in pay for four years – a rate that some considered too low. Their support, along with the new score, will help drive focus on the last remaining hurdle – how to pay for the changes. This lack of progress in identifying offsets—or “pay-fors”—to cover the cost of the legislation is leading some stakeholders, as well as congressional staff members, to talk about the need for another short-term “patch,” or extension. Lawmakers have until March 31 to find a solution.


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