March 5, 2010 - Advocacy Corner

Administration Strategies for Health Reform. With the bipartisan summit behind him, President Obama continues to pursue options to build support for passage of health reform. He recently reached out to Republicans by offering to consider GOP reform proposals for inclusion in overhaul legislation. Proposals include the addition of $50 million to develop state demonstration projects intended to lower the cost of medical malpractice insurance and the option of high-deductible insurance plans that would encourage consumers to enroll in health savings accounts (HSAs). HSAs were established during the Bush Administration, but are philosophically opposed by liberal Democrats. Republicans responded to the President’s offer, saying that such proposals were too little in comparison to a flawed bill and urged him to “start from scratch.”

To shore up support with members of his own party, the President is meeting separately with various groups. This has included liberal House Members, such as the Black Caucus that supports a public option. Centrist Democrats, including the Blue Dogs, are concerned about the cost of the plan, its impact on the deficit and any potential for job creation.

Meanwhile, members of the Administration are focusing on the fiscal side of health reform in answer to critics that the bill would do little to deal with rising health costs. In a Washington Post op-ed today, OMB Director Peter Orzag and White House Health Reform Office Director Nancy-Ann DeParle argue for comprehensive reform as opposed to an incremental approach. Piecemeal efforts, they indicate would mean forgoing …..”building blocks for a feedback loop of reform and improvement in our health-care system. For example, by bundling payments and creating accountable care organizations, as well as by imposing penalties for unnecessary re-admissions and health-facility-acquired infections, physicians and hospitals will be induced to redesign their systems, coordinate care to keep people healthy and avoid unnecessary complications.”

Orzag and DeParle also point out that health care is dynamic and it was critical to make “investments in health information technology, research into what works and what doesn't, and an Independent Payment Advisory Board of doctors and other medical experts [to] make[ing] recommendations to improve the Medicare system.”

Reconciliation, which requires a simple Senate majority versus 60 votes (see Advocacy Corner 3/26), is the preferred mechanism to pass reform and Democratic leaders are preparing their game plan. This route, however, is not without major challenges, which include unlimited amendments among other hurdles. Healthcare overhaul remains a very heavy lift at this point.

Certification Process Rule Released. Essential to moving forward on implementation of meaningful use is the process for certifying EHRs. Earlier this week, National Coordinator Dr. David Blumenthal announced that HHS would soon publish a Notice of Proposed Rule Making (NPRM) to create both temporary and permanent programs for certifying health information technology. To expedite adoption, the temporary program would permit the same entity to both test and certify initial EHR products for providers seeking incentive payments under the Medicare and Medicaid Incentive Program. A subsequent permanent program will separate testing and certification responsibilities as well as add accreditation requirements. Once the NPRM is published in the Federal Register, public comment periods begin with 30 days for the temporary program and 60 days for the permanent program.

Standards Committee Workgroup to Hear CHIME Member Testimony. With the goal of bringing forward “real-world” implementation experience, the Standards Committee Implementation Workgroup is holding a hearing on March 8, entitled, “Implementation Starter Kit: Lessons & Resources to Accelerate Adoption.” Hospital witnesses accompanied by their EHR vendors will address questions of readiness for meaningful use. On the hospital side, questions focus on quality reporting requirements and the approach to use of technology with similar questions to vendors on possible solutions to these challenges. CHIME members testifying are David Muntz/Baylor, Charles Christian/Good Samaritan, Mitzi Cardenas/Truman Medical and Michael Sauk/ University of Wisconsin. Click for the hearing agenda and for audio access.

Other panels include public witnesses from ONC, the states of Vermont and Alabama, NCI and NIST; and an Innovations panel with witnesses serving the homeless as well as others representing Group Health, SureScripts and MedNet.