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Washington Debrief: OIG Identifies MU, Interoperability as Top Management Challenges

November 24, 2014
by Jeff Smith, Vice President of Public Policy at CHIME
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Top News

HHS Watchdog Identifies MU, Interoperability as Top Management Challenges

Key Takeaway: The Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) issued a report last week identifying “the meaningful and secure exchange and use of electronic health information” among the Top Management Challenges facing the department for the near future.

Why it Matters: This yearly OIG report looks at management and performance challenges for HHS, and this is the first year that meaningful use participation and interoperability have made the list. It is an important acknowledgement from HHS’s watchdog that the program is not as stable as some would believe and that increased visibility by HHS leadership is needed to attain the promise of IT in healthcare.

This year’s list of HHS Top Management Challenges (TMCs) was published by the OIG last week, identifying 10 areas on which the Department needs to focus, including managing health insurance marketplaces, expanding oversight of Medicaid fraud, waste and abuse protections, and ensuring food and drug safety. “These challenges reflect continuing vulnerabilities that OIG has identified for HHS over recent years, as well as new and emerging issues that HHS will face in the coming year,” the OIG said. Historically, OIG has identified privacy/security and program integrity concerns related to information technology; however, this year the “meaningful and secure exchange and use of electronic health information” received its own category as a challenge for the department.

Specifically, the OIG says that while participation in meaningful use has led to widespread adoption of EHRs among eligible providers, “significant challenges exist with respect to overseeing the EHR Incentive Programs, achieving interoperability of EHRs, and keeping sensitive health information secure.” It acknowledges that program interest has been high among hospitals and physicians, but “recent data suggest that not all those currently participating will continue in the programs.” It cites dropouts from program participants in 2012 and 2013, concluding that, “If the number of program participants were to decrease, fewer eligible professionals, eligible hospitals and CAHs would progress to Stage 2 meaningful use, which includes a focus on health information exchange,” thus hurting momentum towards interoperability. “Additionally, as the Department works to link payments with care quality, health outcomes or performance as part of health care delivery system reforms, it will need to ensure that EHR and other health information data are accurate and reliable and are protected from misuse.”

It concludes by saying, “As the Department progresses through the development and implementation of meaningful use stages, it should continue to consider feedback from stakeholders to ensure that adopted policies advance the nation towards the Department's stated goals, while appropriately reflecting the changing health IT landscape.”

Legislation & Politics

Health-focused Committees will see New Leadership in 114th Congress

Key Takeaway: The 114th Congress will bring new faces and new agendas to the House committees with jurisdiction over healthcare, as new committee leaders take over.

Why It Matters: Both Republicans and Democrats will welcome new leadership as long-time health champions will retire their posts at the end of 2014, including Rep. Dave Camp (R-MI), Chairman of the Ways & Means Committee; Rep. Henry Waxman (D-CA), ranking member of the Energy & Commerce Committee; and Rep. John Dingell (D-MI), Chair Emeritus of the Energy & Commerce Committee.

Rep. Paul Ryan (R-WI), former vice presidential candidate, will take over the reins of the Ways & Means Committee with the start of the 114th Congress, edging out the current Health Subcommittee chairman, Rep. Kevin Brady (R-TX), for the committee’s top spot.

The Democrats on the Energy & Commerce Committee will be led by Rep. Frank Pallone Jr. (D-NJ). Rep. Pallone currently serves as the ranking member of the Health Subcommittee in the 113th Congress. Rep. Pallone beat Rep. Anna Eshoo (D-CA), the current ranking member on the Communications and Technology Subcommittee to lead the full committee in a highly contested race.

The Appropriations Subcommittee that handles funding for the Department of Health and Human Services (as well as the Department of Labor and Department of Education) has a new leader, Rep. Tom Cole (R-OK), who takes over for Rep. Jack Kingston (R-GA) who retired his seat in an unsuccessful bid for Georgia’s open Senate seat.

Cheat Sheet for House Committees:

Energy & Commerce:

Rep. Fred Upton (R-MI) – Chairman

Rep. Frank Pallone Jr. (D-NJ) – Ranking Member

Rep. Joe Pitts (R-PA) – Health Subcommittee Chairman

TBD - Health Subcommittee Ranking Member

Ways & Means:

Rep. Paul Ryan (R-WI) – Chairman

Rep. Sander Levin (D-MI) – Ranking Member

Rep. Kevin Brady (D-TX) – Health Subcommittee Chairman

Rep. Jim McDermott (D-WA) – Health Subcommittee Ranking Member

Other Committees:

Rep. Tom Cole (R-OK) – Labor-HHS Appropriations Subcommittee Chairman

Rep. Rosa DeLauro (D-CT) - Labor-HHS Appropriations Subcommittee Ranking Member

Draft Ways & Means Committee Bill Focused on Hospital Medicare Payment Policies

Key Takeaway: The draft bill released by Rep. Kevin Brady (R-TX), Chairman of the Health Subcommittee, would revise how hospitals are paid by Medicare.

Why It Matters: This draft legislation represents a significant amount of policy changes, and observers note that it is intended to jump-start a larger hospital payment reform dialogue in the next Congress.

Released in draft form, the Hospital Improvements for Payment (HIP) Act of 2014 would address Medicare payment policies for both inpatient and outpatient hospital stays as well as the Recovery Audit Contractor (RAC) program.

The draft bill would establish a site-neutral hospital prospective payment system (HPPS) for Medicare by FY 2020. In addition, the draft bill would direct HHS to implement a new per diem rate for short hospital stays through the department’s federal rulemaking process. The legislation would authorize a bundled payment system for hospitals, while allowing for payment adjustments for “new technology or innovative item or service.” This legislation is intended to jump-start the larger hospital payment reform dialogue in the next Congress.

A section-by-section summary of the bill has been made available by the Committee here.

Administration

HITSC Reviews Consolidated CDA Study

Key Takeaway: The HIT Standards Committee heard results last week from a recent Electronic Health Record Association (EHRA) study about Consolidated CDA version migrations.

Why It Matters: The Consolidated Clinical Document Architecture (C-CDA), which can help providers meet the transitions of care requirement for Meaningful Use, is supposed to improve interoperability by providing common standards for exchanging patient data including vitals, medication lists and allergies, but if vendors can’t keep up with version migrations, these standards won’t improve care when patients transition between care settings.

The survey administered by EHRA received responses from 70 percent of their members, or 26 vendors. EHRA sent a test C-CDA to implement and provide feedback with the objective of finding out if a new version of the CCDA was released, how would the product react? What would do well or not do well?

In regards to display capabilities, only 66 percent of respondents could display the C-CDA content, while a larger portion, 79 percent, could store it. The survey also considered whether the system would accept a C-CDA with two template IDs or both the updated version and an older version of a C-CDA. Some 80 percent of respondents could accept the document, but this would cause complexities for testing, create a burden on senders to create both versions for the C-CDA and might cause the sender to have duplicate data in its system. Their recommendations to the HITSC include better education about future C-CDA versions, and backward compatibility testing for each update.

For more information about this presentation and an audio recording of the HITSC meeting, click here.

Edited by Gabriel Perna for style purposes


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