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More Feedback on CMS Rulemaking

January 12, 2010
by David Raths
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As we all try to digest the CMS Notice of Proposed Rulemaking (NPRM) for EHR incentives and the ONC Interim Final Rule (IFR) on Standards and Certification Criteria, I think it’s important for us to hear from as many knowledgeable people in the field as we can, because they might have an objection or idea we hadn’t considered.

Initially I wrote a little bit about what I noticed as the major distinctions between the HIT Policy Committee recommendations and the CMS rule. I also noted the objections of some of the large provider organizations such as the American Hospital Association.

A Jan. 8 eHealth Initiative policy webinar gave some industry leaders a chance to weigh in. While they all were highly supportive of the overall approach taken by CMS, several panelists noted some gaps or timing issues they were concerned about.

Glen Tullman, CEO of software vendor Allscripts, noted that not enough small physician practices were consulted in the process, and that in the future small advisory groups might represent this key segment. He and others thought that paper-based attestations may by problematic, and he asked whether the vendors could play a third-party role in gathering and reporting that information.

Karen Bell, MD, senior vice president for health information technology at Masspro, Massachusetts’ quality improvement organization, noted that the timing of the development of regional extension centers may be too late to help many providers achieve meaningful use in 2011, and many may have to bump over to 2012.

She echoed concerns of provider organizations that hospital-based physicians are excluded from incentives, noting that under the guidelines as proposed at least 27 percent of physicians would not be considered “eligible professionals.” She also mentioned something I hadn’t heard before: that hospitals in Puerto Rico and the Virgin Islands are left out of the hospital incentive program. If someone has a good explanation for that, please let me know.

Finally, Bell expressed concern that the quality reporting requirements may add too much administrative burden for both providers and CMS. She joked that quality reporting might bring unemployment down because it will require so many workers to track.

Micky Tripathi, PhD, president of the Massachusetts eHealth Collaborative, sits on the HIT Policy Committee. He said his biggest concern is that neither the IFR nor the NPRM addresses clinical lab results delivery, which he has referred to as the “Achilles heel” of meaningful use, and the most difficult aspect of interoperability. The rules, he said, make a mistake in only specifying standards for public health delivery, not delivery to ambulatory practices.

Some panelists noted that it was realistic and a good thing that the IFR didn’t stress much about HIE participation in the first year.

But Tripathi said he thought there was a little bit of a disconnect between the huge federal effort to support statewide HIE development and the new rules. It seems like they exist in separate worlds, he said.

Which aspect of the NPRM and IFR concerns you the most?

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