Wednesday, April 29, 2009

NCVHS Executive Subcommittee Hearing Defining "Meaningful Use"

The National Committee on Vital and Health Statistics (NCVHS) is an advisory body to the Department of Health and Human Services. The committee is considering options for defining "meaningful use" of Electronic Health Records (EHR) as it pertains to the Medicare and Medicaid financial incentives under the American Recovery and Reinvestment Act (ARRA).

I have been keeping up with the NCVHS Executive Subcommittee hearing for defining "Meaningful Use" by audio stream on the NCVHS agenda web site and via Twitter on the
NCVHS Meeting Twitter Stream (special thanks to Sherry Reynolds and Anthony Guerra who kept tweeting information. :-)

Also there is a great conversation going on at the John D. Halamka, MD, Life as a Healthcare CIO Blog. John proposed a potential basci meaningful use definition to “Processes and workflow that facilitate improved quality and increased efficiency.” You can also view Dr. Halamka's PowerPoint Presentation which gives an overview of his testimony.

Blackford Middleton M.D., corporate director of clinical informatics research and development at Partners Healthcare in Boston, said that "we should not set our sights too low" and risk hampering long-term advancements in quality.

John Tooker M.D., CEO of the American College of Physicians, said we need to make sure that the definition of meaningful use includes software certification from the Certification Commission for Healthcare Information Technology (CCHIT). I agree, and think that HHS will do well to build on the exisiting work of CCHIT and others.

Fred Trotter of Free/Libre and Open Source (FOSS) Health Software testified. He has extensive experience with FOSS in Health Information Exchange. He is currently the Chief Information Architect at HealthQuilt, which is a prototype HIE in Houston, Texas. Trotter asked why this meeting was even taking place and why it is necessary to provide incentive funding before an industry like healthcare would computerize. “We’re here because we’ve had a massive, catastrophic market failure,” Trotter said. Sellers of proprietary healthcare IT systems “have failed to provide a compelling option that doctors can buy.”

Judy Murphy, RN, FACMI, FHIMSS Vice President, Information Services Aurora Health Care, Milwaukee, WI testified as a panelist before the Executive Subcommittee on "Panel 6: The 'Glide Path' to Meaningful Use for 2011 and Beyond for Providers" in support of answering the big question: what path do we follow and how do we know when we’ve arrived?

During her testimony, this nursing leader discussed six key themes regarding the definition for “meaningful use” and the roadmap to achieve it:
  • Interoperability
  • Accessibility
  • Personal Health Records
  • Adoption
  • Measuring Success
  • Education

“Each theme incorporates one of my biases - a very strong patient point of view. Nurses, in general have this partiality. There are 2.9 million practicing Registered Nurses, who comprise 55% of the U.S. health care workforce. As the providers who spend the most time with patients, particularly in hospitals where we are the caregiver and patient advocate 24/7, we have always had a solid focus on seeing things from the patient’s vantage point.”

Micky Tripathi, president and chief executive officer of the Massachusetts eHealth Collaborative (MAeHC), spoke of the need for interoperability and expressed that Health Information Exchange (HIE) would be critical to the use of EHR's. He is also a member of the Board of Directors of MA-SHARE, a community utility service for state-wide clinical data exchange also in Massachusetts that has had great success.

Mark Leavitt MD, PhD, chair of CCHIT, testified at the National Committee for Vital and Health Statistics (NCVHS) Executive Subcommittee hearings on the topic of “EHR Product Certification” and “meaningful use” as they apply to the American Recovery and Reinvestment Act (ARRA).
You can download Dr. Leavitt’s CCHIT presentation for the NCVHS

Overall, I think that the meeting was good start and look forward to seeing future developments.

1 comment:

  1. The recently enacted Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act (ARRA), authorized Medicare and Medicaid incentive payments and penalties to encourage physicians and hospitals to adopt and use electronic health records (EHRs). To be eligible for these incentives, physicians and hospitals must demonstrate the “meaningful” use of electronic health record (EHR) technology that is certified as meeting standards of interoperability, clinical functionality, and security. ARRA directs the Secretary to develop and approve EHR standards by the end of 2009 and to establish a program to certify which EHR systems meet these standards.

    Starting in 2011, physicians who meet the definition of a “meaningful” EHR user (including exchanging electronic health information to improve health care quality and coordination) will be eligible for up to $44,000 in Medicare bonus payments over a five-year period. Physicians who are not meaningful EHR users by 2015 will see their Medicare reimbursement reduced by up to 5 percent in 2019 and subsequent years if the Secretary finds that the proportion of meaningful users is less than 75 percent. Eligible professionals are those that meet the Medicare definition of a physician, i.e., state-licensed doctors of medicine, osteopathy, dentistry, podiatry, and optometry, as well as licensed chiropractors. Eligible professionals are those that meet the Medicare definition of a physician section 1861(r) of the Social Security Act.

    Beginning in 2011, hospitals who meet the definition of “meaningful” EHR user will also be eligible for bonus payments. For hospitals subject to the inpatient prospective payment system (IPPS), the amount of the payment incentive depends on when the hospital first demonstrates meaningful use of a certified EHR system, the size of the facility, and the hospital’s Medicare share. The incentive payment will phase-out over a four year period, such that hospitals receive 75 percent of the applicable bonus payment in year two; 50 percent in year three; and no incentive payment in subsequent years. Hospitals that are meaningful users beginning in 2011, 2012 or 2013 will receive a full four year of incentive payments based on the aforementioned schedule. Hospitals that become meaningful users in 2014 or 2015 will only receive three or two years of incentive payments, respectively. Starting in 2015, hospitals that do not show meaningful use of a certified EHR system during the prior year will be subject to reductions in the annual IPPS market basket update.

    Starting in 2011, Critical Access Hospitals (CAHs) who demonstrate meaningful use of EHR will receive expedited and increased payments for health IT costs that would otherwise be subject to depreciation. In 2011 through 2015, CAHs can expense health IT costs that would otherwise be eligible for depreciation, which will allow them to receive Medicare reimbursement for these costs shortly after incurring the expense, rather than over a multi-year depreciation schedule. In addition, Medicare reimbursement to CAHs for health IT costs will be enhanced by providing an additional 20 percentage points in extra depreciation payments in addition to the allowable depreciation amount that is calculated based on the Medicare share formula set forth in the bonus payment policy for IPPS hospitals. Starting in 2015, CAHs that do not show meaningful use of a certified EHR system during the prior year will face a reduction in their payment rate that will phase-up over three years to 1 percent of the currently 101 percent cost-based reimbursement available to CAHs.

    The HITECH Act also included health IT incentives for eligible professionals and hospitals through the Medicaid program. Beginning in 2011, eligible professionals who treat a high volume of Medicaid patients and demonstrate meaningful use of a certified health IT system are eligible for temporary health IT payments. Payments are not to exceed 85 percent of the cost of purchase, implementation, and maintenance and upkeep of certified systems, subject to an overall cap. Maximum program participation is six years. Eligible professionals include non-hospital professionals (doctors, dentists, nurse practitioners, certified nurse mid-wife, and certain physician assistants) who have at least 30 percent of their patient volume from Medicaid; pediatricians with at least 20 percent of their patient volume from Medicaid; and federally-qualified health centers (FQHCs) or rural health clinics (RHCs) with at least 30 percent of their volume from needy individuals. Eligible providers participating in the Medicaid incentives program are not allowed to participate in the Medicare incentives program described above.