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Washington Debrief: With Shutdown Over, HIT Stakeholders Focused on MU Extension

October 22, 2013
by Jeff Smith, Director of Public Policy at CHIME
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Jeff Smith, Director of Public Policy at CHIME

Government Shutdown Over, Focus Turns to MU Extension, Accounting of Disclosures  With the government shutdown behind us, health IT stakeholders in Washington are resuming focus on a pair of priority issues for 2014, the proposed MU2 extension and accounting of disclosures.

CHIME has already led the way towards engaging Congress on the need to allow flexibility on Meaningful Use in 2014. A few weeks ago, 17 US Senators sent a letter to HHS recommending a year-long extension for providers who need it, while enabling those providers who can meet Stage 2 requirements to do so.

In comments made during a plenary session on October 9 at the CHIME13 Fall CIO Forum, former National Coordinator Dr. Farzad Mostashari advised providers not to count on additional time to meet Stage 2 or Stage 1 revised criteria in 2014. He underscored the difficulty of getting regulatory changes made at a time when healthcare politics over the Affordable Care Act threatens to be conflated with HITECH and the EHR Incentives program. Despite such comments, CHIME will continue to talk with member CIOs and Foundation Firms to gain a clear understanding of how implementation is progressing. CHIME will also continue to work with CMS, ONC and members of Congress to make sure providers have the flexibility they need to implement new 2014 Edition certified EHR technology safely and correctly.

Another issue of emerging interest is that of Accounting of Disclosures. Recently, the Health IT Policy Committee’s Privacy and Security Tiger Team issued a request for comment asking for perspectives on what it takes to provide patients with an accounting of disclosures using IT. Specifically, they are looking to find appropriate ways to bring transparency and bolster privacy to the delivery of healthcare. CHIME submitted comments saying that production of an access report is technologically unfeasible and production of an Accounting of Disclosures report for Treatment Payment and Operations across multiple information systems is enormously difficult, expensive and cannot be achieved with technology alone. “Of chief concern to many CIOs is that all audit logs are not created equal. Despite having common data elements recorded across different solutions, there are few, if any, standard ways to generate reports. Stemming from this issue is the complicated and costly task of aggregating audit logs from different systems into a singular report.”

As with the MU extension work, CHIME will work with health IT stakeholders to educate federal policymakers on the benefits and challenges of providing access reports and accounting of disclosures in a digital world.

Healthcare Website Woes Garner Congressional Focus After Shutdown  Just because the government has resumed operations, does not mean that Congress is entering a new era of compromise and agreement. Instead, Senate and House detractors of the Affordable Care Act have doubled down on their calls to have the law repealed due to the hampered performance of Healthcare.gov, the HHS portal to buy health insurance. So far, the numbers indicate that millions of people have visited the website, yet only a small fraction have actually purchased insurance due to glitches and technical flaws in the software. On the wings of such problems, the House Energy and Commerce Committee will hold hearings later this week and a bi-cameral call from Republicans is asking for the resignation of HHS Secretary Kathleen Sebelius. While these calls represent a minority within a minority, it is an indication of where Congress is likely to take its focus heading into 2014 and a signal that controversy will continue into the foreseeable future.

Medicare EHR Incentive Program Attestation Deadline Nearing; Researchers Look at Attestation to Date  Despite the partial government shutdown, hospitals participating in the Medicare Electronic Health Record Incentive Program must still attest to meaningful use of EHRs by November 30 to qualify for an incentive payment in fiscal year 2013. The attestation website continued to operate during the shutdown and educational resources are available at http://cms.gov/. For hospitals reporting on their first year of EHR program participation, the performance period is 90 days; hospitals in their second or third year of participation report on a full fiscal year. FY 2013 ended on September 30, so reporting periods cannot last beyond that date.

On a related note, researchers have analyzed government data on attestation, finding that as of July 2013, two-thirds of hospitals have achieved Stage 1 Meaningful Use, and nearly all are engaged with the program in some way. In a Health Affairs blog post, ONC’s Jennifer King and researcher Julia Adler-Milstein write that the highest rates of Meaningful Use achievement have been among small rural hospitals (76 percent) and medium (72 percent) and large (77 percent) hospitals. They continue by saying, “The Meaningful Use attainment gap between Critical Access Hospitals and the leading hospitals (medium, large, and small rural) narrowed substantially at the end of the 2012 reporting period, but has slightly widened over the first half of 2013.” These findings add to the body of work indicating that the Meaningful Use program has positively influenced hospitals across all setting types to adopt EHRs; however, policymakers have yet to understand how performance will fare under the 2014 Edition CEHRT and new Meaningful Use measures.

Join CHIME Members on Tuesday, October 22 to Discuss Surviving a Meaningful Use Audit  With so much at stake, an IT leader must understand the Medicare and Medicaid audit documentation requirements to prepare their organizations, prior to and after attestation. Pamela McNutt, senior vice president and CIO at Methodist Health System, and Liz Johnson, vice president of applied clinical informatics and CCIO at Tenet Healthcare have experienced a Meaningful Use audits and will share their insights as to what their organizations experienced and how they interacted with the audit firms.

Additionally, CHIME staff will provide updates to CHIME members regarding the most recent wave of audit notifications.

This public policy briefing is designed to:

  • Provide CHIME members an overview of what documentation is expected during an audit;
  • Explain how your EHR vendor can help play an important role in audit compliance;
  • Update CHIME members on ways to ease reporting burdens due to MU attestation or EHR upgrades.

Please join us for this important and timely briefing on Tuesday, October 22 at 2:00 PM ET. Register here.

Meaningful Use Audit Notifications Update  Nearly 100 CHIME members have contacted CHIME about audit notifications. Many of you have echoed our concern about the timing of these audits given the effort required of IT teams, which are also ramping up in advance of MU attestations.

If you have not yet replied and would like to inform us about a meaningful use audit notification, please send an email to the Public Policy Staff.

If you have additional questions or concerns about the MU Audit process, or are contacted for an audit over the next few weeks, please contact the CHIME Public Policy staff (Sharon Canner, Jeff Smith and Angela Morris).

Edited by Gabriel Perna

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