Healthcare Technology Featured Article

June 23, 2017

What's Ahead for Health IT at the Federal Level?

A new Administration brings a new agenda and changes in priorities. How does this bode for health information technology (health IT)? Here’s a quick look at some of the progress that’s been made so far.

Personnel. Unlike a lot of other agencies, many top jobs are filled at the Department of Health and Human Services (HHS) — especially those related to health IT. Tom Price, MD, is now the HHS secretary. Seema Varma is in charge of the Centers for Medicare and Medicaid Services (CMS), which plays pivotal roles in adoption of health IT standards and use of health IT. John Fleming, MS, is the deputy assistant secretary for health technology reform, a newly created position. Donald Rucker, MD, now heads the Office of the National Coordinator for Health Information Technology (ONC). Genevieve Morris, formerly a senior director at Audacious Inquiry, has assumed the role of ONC’s principal deputy national coordinator for health information technology. Scott Gottlieb, MD, has been confirmed as commissioner of the Food and Drug Administration, which has some health IT responsibilities, especially when it comes to medical devices.

To be sure, other top jobs are waiting to be filled at HHS. However, the Department seems to be ahead of the curve when it comes to the hiring and confirmation process for positions related to health IT.  

Programs. We are beginning to see progress in programs and regulations related to health IT and fighting the opioid crisis.   

Tweaking health IT requirements and reducing physician burden. This is happening right out of the gate. The first example was CMS’ Notice of Proposed Rulemaking for the Fiscal Year (FY) 2018 Hospital Inpatient Prospective Payment System (IPPS). CMS proposes increasing operating payment rates by 1.6 percent for general acute care hospitals that are paid under the IPPS rule, provided they successfully participate in the Hospital Inpatient Quality Reporting Program and engage in meaningful use (MU) of electronic health records (EHR). The proposed rule would eliminate payment adjustments for eligible hospitals that demonstrate that MU compliance is not possible under the ONC’s Health IT Certification Program.

Changes to MACRA. CMS also was quick to issue a new proposed rule on June 20, which updates requirements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  According to a 26-page Fact Sheet summarizing the rule, 2018 requirements continue the themes of reduced burden for physicians in terms of participation and technology. Among other features, participation requirements for practices without high volumes of Medicare patients will be ratcheted back. This will result in significant numbers of small and rural practices additionally being exempt from the Merit-based Incentive Payment System (MIPS) in 2018. Providers can create virtual groups to qualify for MIPS and report on various metrics. Reporting for Advancing Care Information and Improvement Activities will be based on a minimum of 90 days. The rule proposes continued use of the 2014 Edition of CEHRT (Certified Electronic Health Record Technology) and encourages the use of 2015 Edition, adding bonus points for caring for complex patients or using the 2015 Edition exclusively. In developing the proposed rule, the government claims to have taken into account the views of 100 stakeholder organizations and over 47,000 people since January 1. Provider pushback is effective, as we have seen in implementation of ICD-10, for example.  It will be interesting to see how policies going forward will reflect clinicians’ perspectives.     

Health IT is important, but…  We have seen several signals that suggest health IT is important. For example, top positions related to health IT appear to have headed HHS’ hiring queue. A new, very high-level position — deputy assistant secretary for health technology reform — was created. No time was wasted in getting the HIT Advisory Committee off the ground. That said, the Administration’s new budget for fiscal year (FY) 2018 indicates a big budget cut for ONC. HHS’ Budget in Brief shows a $22 million cut for ONC and a staffing reduction of 26; this leaves ONC with $38 million for FY 2018 and 162 employees. According to the document, the funding will be used to focus on two priorities: interoperability and EHR usability.

It also suggests monies will be available for activities specified under the 21st Century Cures Act, including funding the HIT Advisory Committee; curbing information blocking; prioritizing work on standards coordination, implementation, and testing; and developing pilots to accelerate industry progress towards interoperability. It’s possible that the Trump Administration is negotiating; that is, going in low for an opening bid when it comes to the budget, knowing that things will be bargained upward. Many speculate that this budget is dead on arrival. It’s a safe bet that things might change as the budgeting process unfolds, especially in light of the outpouring of support for ONC by such stakeholders as the Healthcare Information and Management Systems Society (HIMSS), the College of Healthcare Information Management Executives (CHIME), the American Health Information Management Association (AHIMA), and the American Medical Informatics Association (AMIA). While it is too soon to tell the impact of next FY’s budget on ONC and other health IT activities in HHS, ONC still has a key role to play if things stay as they are.  

Moving forward with health IT standards and policy. Staffing the new HIT Advisory Committee is well underway, with members to be announced in July. The Committee was created under the 21st Century Cures Act, which sunsets and combines the existing HIT Policy and Standards Advisory Committees. Secretary Price said as much at the recent Health DataPalooza. He told the audience that a burdensome and rigid regulatory environment may mitigate the benefits inherent in health IT and the exchange of health care data. He also emphasized a hands-off approach to health IT oversight. That said, regulations cannot and will not go away entirely. While there may be a reduced number of regulations, HHS may need to piggyback on required rule making — such as the IPPS — for issuing some of its health IT policy guidance

A new head tweak master is created? John Fleming, MS, is the deputy assistant secretary for health technology reform. It is a newly created position whose duties have not been fleshed out. Recently, Secretary Price asked stakeholders to envision a reorganized HHS and what that may look like. Connecting the dots and reading the tea leaves, will health IT functions be consolidated in this shop? Will Fleming be in charge of coordinating health IT functions and health IT-related policies among the various HHS agencies with health IT responsibilities? Will he have a role in tweaking requirements under MACRA and implementing results from new HIT Advisory Committee?

The opioid epidemic will continue to drive policy and programmatic initiatives. Sadly, the opioid epidemic is not ending anytime soon. The high-level interest in the topic and its scope will continue to create new policies and programs at HHS. Health IT will be a key part of the solutions that will arise, with increasing emphasis for PDMP interoperability and use of electronic prescribing for controlled substances.

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