FI­NANCE: Fewer health­care transactions, but value of deals surges

Lat­est rules de­lay some dead­lines, push en­cryp­tion

Modern Healthcare - - FRONT PAGE - Joseph Conn

Di­ges­tion and some dys­pep­sia by health in­for­ma­tion tech­nol­ogy users and lead­ers con­tin­ued af­ter three fed­eral rules—run­ning a com­bined 1,354 pages—were re­leased by HHS late last month.

The largest of the three rules—and prob­a­bly the most wel­comed and least con­tro­ver­sial—was the 672-page fi­nal rule cov­er­ing the so-called Stage 2 mean­ing­ful-use cri­te­ria. It sets the num­ber and height of hur­dles providers must clear to de­clare them­selves mean­ing­ful users of health IT and re­ceive fed­eral in­cen­tive pay­ments un­der the Amer­i­can Re­cov­ery and Rein­vest­ment Act.

De­spite rep­re­sent­ing “a tsunami of change” for providers, there also is con­ti­nu­ity be­tween the ar­chi­tec­ture of the new Stage 2 rules and their pre­de­ces­sor Stage 1 rules re­leased in 2010, ac­cord­ing to Pat Wise, vice pres­i­dent for health­care in­for­ma­tion sys­tems for the Chicago-based Health­care In­for­ma­tion and Man­age­ment Sys­tems So­ci­ety. Both cre­ate a set of core cri­te­ria that ev­ery­one must meet and a sec­ond set of “menu” cri­te­ria from which providers may choose their tar­gets.

“Folks un­der­stand the con­cept, and I’m glad they’ve car­ried it forth,” Wise said. Most of what were menu items in Stage 1 have be­come core cri­te­ria in Stage 2, she said. “That gives the in­dus­try a road map as to what’s com­ing. There is a progress that providers can see and will likely move for­ward in Stage 3.”

A sig­nif­i­cant change in the new rule al­lows those early par­tic­i­pants in the EHR in­cen­tive pro­gram a one-year ex­ten­sion of the Stage 1 cri­te­ria, Wise said. Ini­tially, those providers who met Stage 1 cri­te­ria for 90 days in 2011 were to be re­quired to meet a full year of Stage 2 cri­te­ria in fis­cal 2013, be­gin­ning Oct. 1 this year for hos­pi­tals and cal­en­dar year 2013 for physi­cians and other “el­i­gi­ble pro­fes­sion­als.” For both provider types, the new start dates for Stage 2 were pushed back one year.

In ad­di­tion, providers meet­ing Stage 2 re­quire­ments in 2014 would have to do so for only 90 days, not the full year as was orig­i­nally pro­posed. Also, of­fice-based physi­cians, be­gin­ning no later than 2014, can sub­mit in batches the re­quired at­tes­ta­tions that they’ve met their mean­ing­ful-use re­quire­ments, a re­lief for large group prac­tices from wran­gling physi­cians one-by-one to at­test.

In a sep­a­rate rule, the Of­fice of the Na­tional Co­or­di­na­tor for Health In­for­ma­tion Tech­nol­ogy came up with its 2014 stan­dards and cer­ti­fi­ca­tion cri­te­ria for EHRs.

The big news in the 474-page ONC rule is that to be el­i­gi­ble for use in the fed­eral in­cen­tive pay­ment pro­gram, EHRs must use de­fined sets of stan­dards for mes­sage con­tent and trans­port as well as clin­i­cal vo­cab­u­lar­ies so “ev­ery­body is speak­ing the same lan­guage with com­mon code sets,” said Dr. John Halamka, chief in­for­ma­tion of­fi­cer for Beth Is­rael Dea­coness Med­i­cal Cen­ter, Bos­ton. Halamka also serves as vice chair­man of the fed­er­ally char­tered Health IT Stan­dards Com­mit­tee, which ad­vised ONC on this rule.

“I think you’ve elim­i­nated data si­los,” Halamka said. “And they said that it couldn’t

hap­pen in our life­time.”

Providers are re­quired to use soft­ware cer­ti­fied to the 2014 cri­te­ria by Oct. 1, 2013, (for hos­pi­tals) or by Jan. 1, 2014, (for physi­cians and other el­i­gi­ble pro­fes­sion­als), but they can up­grade their EHRs to meet the new stan­dards at any time.

ONC rule­mak­ers “hit the bal­ance fairly well,” Halamka said. “Some of the stuff is hard, but it’s doable.”

The mean­ing­ful-use rule also con­tains a sub­tle, but force­ful, en­cour­age­ment for hos­pi­tals, physi­cians and oth­ers who han­dle pa­tient-iden­ti­fi­able records to take a new look at data en­cryp­tion.

“Re­cent HHS anal­y­sis of re­ported breaches in­di­cates that al­most 40% of large breaches in­volve lost or stolen de­vices,” the CMS rule writ­ers said. “Had these de­vices been en­crypted, their data would have been se­cured. It is for these rea­sons that we specif­i­cally call out this el­e­ment.”

En­ti­ties cov­ered un­der the Health In­sur­ance Porta­bil­ity and Ac­count­abil­ity Act al­ready must per­form a se­cu­rity risk as­sess­ment, in which the use of en­cryp­tion is “ad­dress­able,” which means “that you need to con­sider that con­trol as part of your mit­i­gat­ing con­trols for your risk as­sess- ments,” ac­cord­ing to Lisa Gal­lagher, se­nior di­rec­tor of pri­vacy and se­cu­rity for HIMSS.

Fi­nally, HHS is­sued a 208-page rule for­mally adopt­ing what it had pro­posed ear­lier: to de­lay to Oct. 1, 2014, the start date for the na­tional con­ver­sion to the ICD-10 fam­ily of di­ag­nos­tic and pro­ce­dural codes.

The Amer­i­can Med­i­cal As­so­ci­a­tion re­mains wary of the planned ICD-10 com­pli- ance date. In June, its House of Del­e­gates asked for an eval­u­a­tion of the fea­si­bil­ity of skip­ping ICD-10 al­to­gether and adopt­ing ICD-11, which is un­der de­vel­op­ment and could be re­leased as early as 2015. Pre­vi­ously, the AMA had asked for the CMS to push the ICD-10 com­pli­ance date back to 2015.

In the same rule as ICD-10, the CMS also cre­ated the frame­work for a long-de­layed na­tional iden­ti­fier sys­tem for health plans, man­dated by HIPAA.

AMA Pres­i­dent Dr. Jeremy A. Lazarus, in a pre­pared state­ment, wel­comed the plan iden­ti­fier as “a mean­ing­ful step to­ward a stream­lined billing sys­tem.” But Lazarus noted that over the past three years, the AMA has “strongly ad­vo­cated” to “ex­pand the scope” of the iden­ti­fier “to in­clude each en­tity in the health­care billing and pay­ment process.” That ex­pan­sion ex­tends to “a clear iden­ti­fi­ca­tion of a pa­tient’s ben­e­fit plan and the rel­e­vant fee sched­ule,” Lazarus said.

The MGMA also wants a “more gran­u­lar” iden­ti­fi­ca­tion sys­tem for plans and sub­plans, ac­cord­ing to Robert Ten­nant, the or­ga­ni­za­tion’s se­nior pol­icy ad­viser. HHS sees this rule as a be­gin­ning point, Ten­nant said, but “you ask your­self, when was this first man­dated by Congress? It was 1996. And when is the com­pli­ance date? 2016. That’s 20 years. The ad­min­is­tra­tion has missed a huge op­por­tu­nity to sim­plify the claims cy­cle. We’ve waited 20 years, and it’s still not go­ing to help providers as much as they could.”

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