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Washington Debrief: Sen. Alexander says EHR Improvements Are Top Priority

June 1, 2015
by Leslie Krigstein, Interim Vice President of Public Policy
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Leslie Krigstein, Interim Vice President of Public Policy

Top News

Senate Hearings to Investigate Ways to Improve EHRs

Key Takeaway:  Senate Health, Education, Labor and Pensions Committee Chair Lamar Alexander (R-T.N.) said making electronic health records (EHRs) work for clinicians and scientists is among his top priorities during a visit to Vanderbilt University last week.  He and HELP Ranking Member Sen. Patty Murray (D-Wash.) have established a bipartisan workgroup to identify ways to improve EHRs.

Why it Matters:  The HELP Committee has long been engaged with the health IT stakeholder community and is currently working on policies meant to enable efforts like the President’s Precision Medicine Initiative.  This latest announcement of a bipartisan workgroup likely portends hearings and legislation meant to address lingering challenges with interoperability.

According to HELP Chairman Alexander and Ranking Member Murray, the Senate will go “more in depth” than the House Energy and Commerce (E&C) Committee to fix problems with EHR systems built with $30 billion in federal incentive payments.  During a Vanderbilt University workshop on creating a million-patient precision medicine database, Sen. Alexander said a bipartisan group of staff had been meeting weekly with staff from ONC and the office of NIH Director Francis Collins to identify ways to improve EHRs.  As part of this work, summer hearings are being planned and Mr. Alexander urged scientists to bring specific ideas forward by September to incorporate into Senate legislation next year, meant to mesh with the House Energy and Commerce Committee’s 21st Century Cures Initiative.  There are, as yet, no dates set for hearings.


EHR Incentive Program Crosses $30B Threshold

Key Takeaway:  According to CMS data, more than $30 billion in incentive payments have been disbursed to eligible hospitals, eligible professionals and critical access hospitals since the program began in 2010.

Why it Matters:  Original estimates by the Congressional Budget Office (CBO) expected roughly $31.2 billion in incentives to be spent by CMS through 2017, before federal number crunchers recouped some $1.1 billion through penalties for noncompliance.  With 2016 representing the last year that providers participating in the Medicare program can receive incentives, health IT executives should have a firm grasp of what on-going maintenance and compliance costs will be, moving forward.

CMS data released last week, and current through the month of March, gave stakeholders a macro view of how the EHR Incentive Program has fared more than five years since passage of HITECH.  According to CMS, more than $30 billion in incentive payments have been paid, and:

  • $20.2 billion paid through Medicare;
  • $9.4 billion paid through Medicaid; and
  • $400 million paid to Medicare Advantage.

Moreover, the data detailed how many unique providers have received incentive payments, which could be for meeting the Medicare meaningful use criteria or for meeting Medicaid “adopt, implement or upgrade” criteria.  Numbers indicate that roughly 429,000 EPs and 4,800 EHs have received payments, which represent roughly 80 percent of all EPs and 96 percent of all EHs / CAHs.  The data breakdown also finds that roughly 7 percent (38,472) of all EPs have successfully met the requirements of meaningful use Stage 2.  And approximately 29 percent (1,440) of EHs have met Stage 2 requirements.  It should be noted that not all EPs and EHs / CAHs are eligible to meet Stage 2 criteria in 2014 or 2015.  Separate CMS analysis indicate that roughly one-third of EHs scheduled to meet Stage 2 in 2014, and more than two-thirds of EPs, opted to meet MU using alternative pathways.  With CMS expected to finalize proposals that would shorten the 2015 EHR reporting period to 90 days and slide hospitals from a fiscal year to a calendar year, stakeholders will not know how providers fared in 2015 until well into 2016.

Legislation & Politics

21st Century Cures Unanimously Passes House Committee, Future Uncertain

Key Takeaway:  The legislation know as 21st Century Cures, or H.R. 6, passed the Energy & Commerce Committee recently with the full support of all 51 Republicans and Democrats. Several sections will directly impact health IT policy should the Senate take up similar language.

Why it Matters:  Sections 3001 and 2241 – 2243 would codify new provisions meant to improve interoperability of health IT and prohibit FDA from regulating most health IT functionality, respectively.  As these measures are considered by the Senate, healthcare IT executives should understand how these sections could impact their day-to-day lives.

After sailing through the Energy & Commerce subcommittee on Health, the full E&C Committee voted 51-0 to pass H.R. 6, the 21st Century Cures Act.  The bill would impact health IT in several ways, but perhaps most importantly are sections dealing with interoperability and FDA oversight of health IT.  The intent of Section 3001 is to “refocus national efforts on making systems interoperable and holding individuals responsible for blocking or otherwise inhibiting the flow of information throughout our healthcare system.” For a detailed breakdown of the section, click here.  Meanwhile Subtitle N, “Sensible Oversight for Technology Which Advances Regulatory Efficiency,” is meant to support innovation around health software and wireless platforms by “updating the regulatory laws around software and creating clarity for developers and reviewers alike.”  For an overview of the SOFTWARE Act, click here.

Despite the fanfare coming from E&C, the path to the President’s desk will be a long one.  The Senate is deliberating over its own version of 21st Century Cures, known as the Healthier Americans Initiative.  And while E&C leadership were hoping to have a full House vote by the end of June, Senate leadership has indicated their timeline extends into 2016.  So while the legislation is important to understand, equally important is the knowledge that a lot can change between now and next year. 

CHIME News and Notes

CHIME Applauds Changes to MU Stage 2, Calls Stage 3 ‘Too Ambitious’

Key Takeaway:  In official comments submitted to the Centers for Medicare & Medicaid Services (CMS), the CHIME called federal plans for the third stage of meaningful use too ambitious and in need of several important changes. The organization also voiced overwhelming support for a corresponding CMS proposal that would shorten meaningful use reporting in 2015 from a full year to any continuous 90-day period.

Why it Matters:  Several provider organizations expressed doubt over their abilities to meet Stage 3 requirements in 2018, leading to many organizations asking CMS to delay finalization of their proposed rule until more experience can be gained with modified Stage 2 requirements.

While recognizing the agency’s effort to streamline program participation through a reduced number of objectives and harmonized reporting periods, CHIME deemed the sum total of proposals for Stage 3 of the EHR Incentive Program “unworkable.”  “Were all requirements finalized as proposed, we doubt many providers could participate in 2018 successfully,” CHIME said in comments. “And with so few providers having demonstrated Stage 2 capabilities, we question the underlying feasibility of many requirements and question the logic of building on deficient measures.”

CHIME urged CMS to make several changes to the proposed rule for Stage 3, including:

  • A 90-day reporting period for the first year of Stage 3 compliance, at least for payment adjustment purposes;
  • Modify requirements for and retain the 90-day reporting period for providers attesting to meaningful use requirements for the first time, whether in a Medicare or Medicaid context;
  • Eliminate patient action thresholds for the care coordination objective;
  • Reduce the number of required measures in multi-measure objectives, health information exchange and care coordination;
  • Create hardship exceptions for providers switching vendors;
  • Allow providers to take a 90-day reprieve during any program year for upgrades, planned downtown, bug fixes related to new technology or optimizing the use of new technology within new workflows; and
  • Allow, in limited circumstances, paper-based means to achieve measure thresholds.

Click here for access to CHIME’s full comments.  Stage 3 comments were due last Friday, but members can still submit comments on proposed modifications to Stage 2.

Edited by Gabriel Perna for style purposes.

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