Congress Focuses on Meaningful Use Delay and Interoperablity
On July 30, 2015, Rep. Renee Ellmers (R-NC) introduced H.R. 3309 – the Further Flexibility in HIT Reporting and Advancing Interoperability Act or Flex-IT 2 Act – to address concerns with CMS’ proposed rules for Meaningful Use Stage 3 rules for the Medicare and Medicaid EHRs Incentive Programs. The legislation encompasses 5 measures: (1) delay Stage 3 Rulemaking until at least 2017, or MIPS final rules or at least 75 percent of doctors and hospitals are successful in meeting Stage 2 requirements; (2) harmonize reporting requirements (MU, PQRS, IQR) to remove duplicative measurement and streamline requirements from CMS; (3) institutes a 90-day reporting period for each year, regardless of stage or program experience; (4) encourages interoperability among EHR systems; and (5) expands hardship exemptions.
“Today’s legislation is key to supplying healthcare providers with flexibility and certainty, as they struggle yet again to meet the Centers for Medicare & Medicaid Services’ (CMS) stringent requirements pertaining to Meaningful Use,” stated Ellmers. “This legislation supplies relief by delaying Stage 3 rulemaking until at least 2017 in order to give providers time to breathe and a reprieve from the unfair penalties. Only 19 percent of providers have met Stage 2 attestation requirements—a clear sign that physicians, hospitals and healthcare providers are challenged in meeting CMS’ onerous requirements. Given this basic fact, I’m uncertain why CMS would continue to push forward with a Stage 3 rule.”
On the Senate side, the Committee on Health, Education, Labor, and Pensions (HELP) recently held a hearing on the practice of “information blocking” and raised the question of whether the federal government, through its program to encourage adoption of electronic health records (EHRs), played a role in encouraging the practice.
“Since 2009, the American taxpayer has spent $30 billion to spur doctors and hospitals to install electronic health records systems—through incentive payments to Medicare and Medicaid providers,” stated Senate health committee Chairman Lamar Alexander (R-TN). “But interoperability—this communication between systems that is so critical to the success of electronic health records—has been difficult to achieve. Information blocking is one obstacle to interoperability, and I’m interested in hearing today from the witnesses the extent to which this is a problem – and the extent to which the government may share in the blame.”
The hearing was the committee’s fourth in a series intended to solve problems with the federal government’s six-year-old meaningful use program meant to encourage adoption of EHRs at doctor’s offices and hospitals. Staff for the chairman and Ranking Member Patty Murray (D-WA) have been meeting with committee members’ staff weekly and meeting regularly with experts and administration officials to build legislation to improve the program. Alexander said the committee would like to complete its work by this fall. He also suggested that the committee might push to delay implementation of the meaningful use program’s Stage 3 rules for use of EHRs.
“My instinct is to say to Secretary Burwell, let’s not go backward on electronic health care records, but let’s not impose on physicians and hospitals a system that doesn’t work and which they spend most of their time dreading,” Alexander said in his opening statement.
In addition to potentially delaying Stage 3 of the meaningful use program, Alexander suggested that he might want to address who owns an individual’s health data, improving interoperability, reducing excessive physician documentation, and improving security and privacy. Murray emphasized “gag clauses,” which prevent providers from speaking publicly about problems associated with EHRs. She asked whether tools or protections were needed to ensure that individuals can safely report on unfair market practices without fear of repercussions. Many of the witnesses at the hearing agreed that EHR vendors should not be allowed to include such clauses. Other issues discussed included legal concerns about anti-competitive behavior, increasing transparency, the need for a “lemon law,” and impact on value-based payment models.