CMS, ONC Announce 2013 Health IT Agenda

Marilyn Tavenner, acting administrator of the Centers for Medicare and Medicaid Services (CMS), laid out her agency's health IT agenda on Wednesday at the annual meeting of the Healthcare Information Management and Systems Society (HIMSS) in New Orleans. Concomitantly, CMS released data showing that the adoption of electronic health records by non-federal U.S. hospitals more than tripled between 2009 and 2012, and that 44% of hospitals now have at least a basic EHR.

The Department of Health and Human Services (HHS), which includes CMS, has set a goal of having 50% of physician offices use what it considers to be EHRs by the end of 2013, Tavenner said. In addition, HHS aims to ensure that 80% of hospitals receive Meaningful Use incentive payments by December.

Tavenner also told the HIMSS attendees that CMS will not again delay the deadline for the switchover to the ICD-10 diagnostic code set, which is scheduled for Oct. 1, 2014. "ICD-10 will go forward as designed," she said.

[ Survey of healthcare CIOs shows good progress on EHRs, but challenges remain. Read more at HIMSS: Hospitals Making Progress on Meaningful Use. ]

In a statement apparently aimed at quieting industry concerns about the Meaningful Use stage 3 proposal from the Health IT Policy Committee, Tavenner said CMS will not promulgate any new rules for the Meaningful Use program in 2013. "We will focus on stage 2, so we can figure out how to design stage 3," she said.

Part of that focus will be to convene stakeholders to look at what can be done to address billing-related features of EHRs that allow providers to "game" the system. But in a press conference following Tavenner's presentation, Farzad Mostashari, national coordinator of health IT, emphatically stated that there won't be any changes in the stage 2 regulations, which are already embodied in a final rule.

CMS and the Office of the National Coordinator for Health IT (ONC) are also putting on a full-court press to accelerate adoption of health information exchange (HIE) in the healthcare industry. To that end, HHS has issued a request for information seeking public input about policies that "will strengthen the business case for electronic exchange across providers," according to a press release.

CMS may propose modifications to the EHR exception to the federal physician self-referral and anti-kickback statutes that allow hospitals to subsidize EHRs for private practices, Tavenner said. Mostashari clarified this statement by noting that it might be possible to expand this exemption to remove barriers to health information exchange.

Other policy levers could also be devised to incentivize data exchange, he said. For example, CMS could create quality measures that encourage sharing of data, or it could add coordination of care metrics to the requirements for accountable care organizations participating in the Medicare shared savings program.

Mostashari did not allude to the announcement earlier this week by five major EHR vendors that they would form an interoperability alliance called CommonWell. But now that the government has turned its Nationwide Health Information Network (NwHIN) Exchange over to a nonprofit organization called the eHealth Exchange, it's clear that the private sector will be expected to play a greater role in building and extending health information exchange. The eHealth Exchange is now working on nationwide standards for HIE with the Interoperability Work Group consisting of EHR and HIE vendors and 19 states, and Surescripts has also formed a nationwide interoperability consortium.

CMS also announced it will encourage Medicare Advantage plans to use its Blue Button technology to allow Medicare patients to download their medical records. Other Medicare beneficiaries can already download medical data spanning three years, Tavenner noted, and more than 300,000 have done so.

Mostashari said ONC will try to standardize Blue Button downloads and make them more user friendly. In addition, he said it's possible that CMS may use its HCAHPS patient satisfaction survey to find out how easy it is for Medicare patients to access their records.

There was just one sour note in this litany of accomplishment and striving: the impact of the sequestration budget cuts. Medicare, like other federal agencies, will see its budget cut 2% as of April 1. That means that providers who attest to Meaningful Use will receive 2% less than they'd expected, along with 2% in payment cuts. (Medicaid incentive payments will be unaffected.) In addition, ONC itself will see a 5% cut in its $60 million budget, Mostashari said.

"There are things that the industry expects us to do that we can't do," he concluded.

As large healthcare providers test the limits, many smaller groups question the value. Also in the new, all-digital Big Data Analytics issue of InformationWeek Healthcare: Ask these six questions about natural language processing before you buy. (Free with registration.)