CHIME voices concerns about proposed ARRA regulations
ANN ARBOR, MI, January 7, 2010 – Reporting, product certification and implementation deadlines represent major concerns that could affect efforts to effectively implement electronic health records under recently proposed federal regulations, according to The College of Healthcare Information Management Executives (CHIME).
CHIME is beginning an intensive review of provisions of the recently released regulations to implement healthcare information technology provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). However, at first glance, several provisions within the regulations merit closer scrutiny and will pose significant challenges for providers hoping to implement electronic health records.
“The nation’s providers definitely need federal stimulus funding to offset the cost of implementing these systems,” said Tim Stettheimer, chair of CHIME’s board, and Regional CIO for Ascension Health and a Senior Vice President and CIO at St. Vincent's Health System. “But it’s important for the regulations to help hospitals in their efforts to succeed, rather than serve as impediments to success.”
The regulations face a 60-day comment period and, after review, changes are expected to be made before they become final. They will provide significant guidance for hospitals and their IT departments in the coming months, and they represent an important step along the path of digitizing patients’ healthcare records, and improving the efficiency and safety of the American healthcare system.
CHIME’s initial analysis of the provisions favors the phased approach used to measure the meaningful use of electronic health records. Through the phased approach, first-year meaningful use criteria will apply to hospitals whenever they are eligible. However, the current schedule places pressure on hospitals that delay in implementing electronic health records, because by 2015, all hospitals and eligible providers would need to meet Stage 3 criteria to avoid payment penalties.
“Adequate time to understand the impact of these new systems and to implement them, are some of my secondary concerns,” said David Muntz, Senior Vice President and CIO of Baylor Health Care System. “My primary concern is the time and effort required to achieve successful organizational change management.”
To qualify for the incentive payments in either Medicare or Medicaid, eligible providers and hospitals must use certified EHRs to meet specific objectives and report specific HIT functionality measures to the Centers for Medicare & Medicaid Services. Additional quality measures also will need to be submitted, and as a whole, reporting requirements will be burdensome; many of the measures will require organizations to gather information that spans both electronic and paper-based systems, such as the percentage of orders entered through CPOE systems.
Initial reporting will be done through attestation to CMS, but that will still require hospitals to provide data on each of the HIT functionality measures.
Quality reporting provisions of the regulation also will require hospitals to develop reporting capabilities, since only nine of the 35 quality measures being proposed in the regulations currently are in use in the Medicare pay-for-reporting program.
For physicians, the use of Physician Quality Reporting Initiative indicators for reporting quality data will be a major challenge, CHIME believes. The proposed regulations indicate that medical groups that qualify for stimulus funding no longer will be eligible for the 2 percent bonus for reporting PQRI data.
The regulations also stipulate that hospital-based physicians are not eligible to receive stimulus payments. That creates a disincentive for healthcare systems and teaching programs from investing in ambulatory records systems for these physician groups.
CHIME also is concerned about the regulations’ burden on providers to demonstrate that they are using “certified EHR technology.” To receive Medicare and Medicaid incentive payments, providers must attest to CMS that the EHR system they use meets the statutory definition of a qualified EHR and has been “tested and certified in accordance with the certification program established by the National Coordinator.” CHIME is concerned that the certification process won’t be known until it is described in a forthcoming proposed rule from ONC, and that neither of the just-released CMS and ONC regulations provide for acceptance of previous CCHIT certification or allows for a transition time between when certification criteria are announced and when providers will be expected to use products certified to those criteria.
CHIME is conducting an intensive analysis of the regulations, primarily through the efforts of its Policy Steering Committee, which is composed of member CIOs who will closely examine the proposed regulations for their potential impact on widespread implementation of EHRs. CHIME also will survey members and seek their input on the regulations. CMS is soliciting comments on many issues. CHIME will submit public comments, and the organization encourages all concerned parties to comment on the proposed regulations as well.
The College of Healthcare Information Management Executives (CHIME) is an executive organization dedicated to serving chief information officers and other senior healthcare IT leaders. With more than 1,400 CIO members and over 70 healthcare IT vendors and professional services firms, CHIME provides a highly interactive, trusted environment enabling senior professional and industry leaders to collaborate; exchange best practices; address professional development needs; and advocate the effective use of information management to improve the health and healthcare in the communities they serve.
Director of Communications
UPDATED: 1/7/2010 9:02:01 AM