The next stage for IT

What to ex­pect as EHR sub­si­dies roll out, and in the wake of midterm elec­tions

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Edi­tor’s note: The fol­low­ing is an ex­cerpt of the tran­script of an ed­i­to­rial we­b­cast, “On your marks; get set for fed­eral EHR pro­gram,” con­ducted by

Mod­ern Health­care on Sept. 29. The four pan­elists dis­cussed and de­bated the govern­ment’s mean­ing­ful-use cri­te­ria that will be used to de­ter­mine who will get fed­eral fi­nan­cial sub­si­dies for their in­for­ma­tion technology pro­grams. The pan­elists were Chip Kahn, pres­i­dent and CEO of the Fed- er­a­tion of Amer­i­can Hos­pi­tals; Don May, vice pres­i­dent of pol­icy for the Amer­i­can Hos­pi­tal As­so­ci­a­tion; Farzad Mostashari, deputy na­tional co­or­di­na­tor for pro­grams and pol­icy in HHS’ Of­fice of the Na­tional Co­or­di­na­tor for Health In­for­ma­tion Technology; and Robert Ten­nant, se­nior pol­icy ad­viser for the Med­i­cal Group Man­age­ment As­so­ci­a­tion. Mod­ern

Health­care re­porter Joseph Conn mod­er­ated the we­b­cast.

Joseph Conn: I lis­tened to a re­cent mean­ing­fu­luse work group meet­ing of the HIT Pol­icy Com­mit­tee, and there was a lot of dis­cus­sion about the tim­ing of go­ing into Stage 2. As you know, they were be­gin­ning work on the Stage 2 mean­ing­fu­luse cri­te­ria—and some dis­cus­sion touched on how they’re go­ing to get feed­back from peo­ple try­ing to im­ple­ment Stage 1. All three of the speak­ers in dif­fer­ent words ba­si­cally raised the same is­sue about maybe mov­ing too fast be­fore we know if any of this stuff in Stage 1 works. How is the ad­min­is­tra­tion go­ing to be han­dling that feed­back loop and mak­ing ad­just­ments into Stage 2 or even mak­ing a se­ri­ous eval­u­a­tion of Stage 1— that maybe the tim­ing thing is just too tight?

Farzad Mostashari: There’s a lit­tle bit of a rock and a hard place on this is­sue. Ob­vi­ously, the ven­dors want as much lead time as pos­si­ble. They’ve asked for a min­i­mum of 18 months be­fore there are any new cri­te­ria. And if you take into con­sid­er­a­tion the time it takes to do reg­u­la­tory process, we’d have to start rule­mak­ing now for Stage 2 if we wanted to en­able as much time as pos­si­ble for Stage 2. On the other hand, there is a real de­sire for em­piri­cism, kind of ev­i­dence-based pol­icy, where we see what the ex­pe­ri­ence is with Stage 1. I think we have to be cre­ative on both ends, and I think we’ll work hard to garner ex­pe­ri­ence as soon as we can.

That means things like the mean­ing­ful-use van­guard, the movers as we call them af­fec­tion­ately, those are the providers who are most ready, work­ing with the ex­ten­sion cen­ters—and sys­tem­at­i­cally gather their ex­pe­ri­ences and un­der­stand what are the cri­te­ria that are dif­fi­cult for them to meet. And what are those that are more dif­fi­cult for even the more-ad­vanced providers to meet in those ini­tial stages. It will also mean that we’re go­ing to need quicker feed­back loops. We can’t have a year be­tween when the at­tes­ta­tion is made and when there is the fi­nal in­for­ma­tion back in terms of what­ever the re­sults of that is. We’re work­ing very hard with col­leagues, and Tony Tren­kle at the CMS (di­rec- tor of the agency’s of­fice of e-health stan­dards and ser­vices) is com­mit­ted to hav­ing a shorter feed­back loop on this Stage 1 ex­pe­ri­ence.

We also have to con­sider ways in which—and I would love ev­ery­one’s in­put on this and cer­tainly will be part of an op­por­tu­nity in the pro­posed rule—to sug­gest other ways on the other ends that we could pro­vide as much flex­i­bil­ity as pos­si­ble. We pro­vided, for ex­am­ple, in Stage 1, the abil­ity to do 90-day re­port­ing for the first year of mean­ing­ful use, so that’s some­thing that peo­ple can com­ment on, whether that should be con­tin­ued or not. There are other ways of achiev­ing that same goal, but I think those are two im­per­a­tives. They’re both im­por­tant im­per­a­tives. We want to learn from Stage 1; we also want to give peo­ple as much time as pos­si­ble to pre­pare for Stage 2, and we just have to work at both ends of that.

Joseph Conn: If the GOP takes the House in Novem­ber, will bud­get-deficit hawks try to re­duce or even elim­i­nate the IT sub­si­dies un­der the Amer­i­can Re­cov­ery and Rein­vest­ment Act?

Chip Kahn: First, we won’t know what the fu­ture is till we get there. And what may oc­cur ... will be a wa­ter­shed elec­tion, and if it is a wa­ter­shed elec­tion, then I think that we prob­a­bly will ex­pe­ri­ence in 2011 some stale­mate. My guess would be—and this is “buyer be­ware” here—that at least into the near fu­ture of all the things that might be af­fected in health re­form, this is one that prob­a­bly wouldn’t be changed. Even if there is leg­isla­tive ac­tion, there won’t be a bill signed by the pres­i­dent that would en­act changes. But I think over time, the jury’s out as to what will be the ef­fect of the elec­tion on the health re­form agenda.

Robert Ten­nant: I agree 100% with that. I think the only thing that I would add would be that health IT and im­prove­ments in the ad­min­is­tra­tive sim­pli­fi­ca­tion ar­eas are one of the few ar­eas in Washington where we’ve seen any bi­par­ti­san agree­ment. So I think we pretty much all agree that we need to im­prove the health­care set—by mak­ing it more ef­fi­cient and im­prov­ing pa­tient care. So I think that may be one of those ar­eas that may be off the ta­ble.

Don May: I agree with both of them, and I think there’s one other nu­ance with this pro­gram that’s im­por­tant to note is: This has be­come a Medi­care pay­ment. And Medi­care pay­ments are en­ti­tle­ment pro­grams. They hap­pen au­to­mat­i­cally. … I be­lieve most of the dis­cus­sion around kind of pulling back, if Repub­li­cans were to win, is re­ally fo­cused around the ap­pro­pri­a­tions side.

May

Kahn

Ten­nant

Mostashari

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