April 2, 2010 - Advocacy Corner

Meaningful Use Rule Continues as Legislative Focus. While CMS reviews the over 2,000 comments on the Proposed Rule for Medicare and Medicaid Programs/ Electronic Health Record Incentive Program, efforts in Congress continue on legislative action to alter rules on the definition and requirements for providers to qualify for incentive payments. Yesterday in a letter to CMS, 27 Senators expressed concern about “the inappropriate exclusion of most physicians working in outpatient centers, and the treatment of hospitals that have multiple campuses that use one provider number.” Pointing to the “all-or-nothing approach in which hospitals would be required to adopt all 23 separate EHR objectives or requirements,” the letter observed that very few hospitals have been able to accomplish these objectives. The letter is identical to one signed by 235 Members of the U.S. House earlier in March.

Legislation to make hospital-based physicians eligible for subsidies under the HITECH act was included in House-passed legislation earlier this year, but not addressed by the Senate. Ranking Finance Committee Member Senator Grassley (R-IA) on March 19 introduced S 3153 that includes this change as well as extends the Medicare payment update for physicians until May 1, making this a must-pass bill.

CMS Innovation Center Created Under New Healthcare Law. In urging passage of health reform, the Administration emphasized that overhaul was about bending the cost curve as well as coverage. The CMS Innovation Center, to be established under the Patient Protection and Affordable Care Act (PL 111-152), authorizes demonstrations to “test, evaluate, and expand different payment structures and methodologies which aim to foster patient-centered care, improve quality, and slow the rate of Medicare cost growth.” Support for care coordination for chronically-ill Medicare patients will include a chronic disease registry, home tele-health technology, care oversight by the beneficiary‘s treating physician, EHRs, and patient-based remote monitoring systems.

The Patient Protection Act requires the development of standards to assure interoperability among Federal and State health and human services programs as a means to derive better value from the Federal investment in healthcare. Standards will promote Federal data matching and electronic documentation. The HHS Secretary may also require states to utilize these standards as a condition for receiving Federal health IT funds.

Other health IT provisions require the establishment of an Interagency Working Group on Healthcare Quality as well as measures to improve public health reporting. Regarding the latter, the Secretary is charged with collecting data on quality and resource use measures used to support health care delivery to implement the public reporting of performance information. CDC is charged with conducting research in real world settings on best practices for improving the delivery of public health services. For a chart with expanded analysis of these and other IT provisions, please see “Health IT or Health Information Policy-related Provisions,” prepared by Nandan Kenkeremath, Managing Principal, Cogon Strategy, Policy & Relations.

How-To Website Could Help with MU Compliance. Among recommendations of the HIT Standards Committee Implementation Workgroup is a proposal to create a website for providers and vendors seeking to meet Meaningful Use criteria. The recommendation, to be offered during the April 28 Standards Committee meeting, picks up on testimony and witness discussion of the March 8 hearing that included CIOs and their vendor partners. Providers, for example, could use this how-to resource to access information on transmission standards for health information exchange. There are questions around an ONC website of this nature, however, regarding the validity of the information, a point raised during the March 24th Standards Committee meeting. ONC staff indicated that like similar Federal websites, all such information is provided as “guidance” and not legal advice.

Congress on Recess. Continuing a two-week recess (March 29-April 9), Congress returns to Washington the week of April 12, leaving further action on the eligible provider, physician reimbursement and other legislation until that time.