Thursday, March 19, 2015

Health IT Implications of the Doc Fix - SGR and MIPS

Permanent legislation has been introduced by bipartisan committee leaders in the House and Senate to permanently replace the sustainable growth rate. The bipartisan, bicameral bill seeks to end the cycle of annual ‘Doc Fix’ crises that have created uncertainty for millions of Medicare providers and beneficiaries for over a decade and also create a system that promotes higher quality care for America’s seniors, according to the announcement on the Energy and Commerce website.


There are some significant health IT implications of the legislation, and although the negotiations are not complete there is fairly strong bipartisan support for the bill. It includes many of the exact provisions proposed a year ago in the SGR fix that was being spearheaded by the Senate Finance Committee. You can read the legislation HERE, but I have peeled off section 2 from the Section by Section analysis created for the Energy and Commerce Committee (very similar to what Senator Wyden used last year :). Read below and learn how Congress plans to roll up meaningful use, value-based payments, and other programs into the Merit-Based Incentive Payment System (MIPS)...

Monday, February 2, 2015

ONC Annual Meeting


The ONC Annual Meeting is February 2-3, 2015. It is being broadcast live HERE.

















National Coordinator and Acting Assistant Secretary for Health Dr. Karen DeSalvo's opening remarks and HHS Secretary Burwell's comments are below:

Dr. DeSalvo:
Last year, when I stood before this ONC Annual Meeting I was just a few days into my tenure as National Coordinator, I was literally fresh off the farm. I shared with you my perspectives as a daughter, as a doctor being as a public health leader and what we had done in post Katrina New Orleans learning how health IT would make a difference in care and public health. I had just purchased an EHR for a hospital we were constructing and have been through three implementations of a health record in the clinical care environment in the outpatient setting and still using EHR's in the practice of medicine. That day I said we would look at how health IT would be a key ingredient in reforming our nation's healthcare system, including focusing on how it would support payment reform and how payment reform would support health IT, I said we would break down barriers and silos that were holding in data and focus on interoperability and save lives to improve the public health. I told you we would risen to everyone's ideas about how to rairpz the floor for health and health information in this nation. I want to remind you all of what we've accomplished in this last year at ONC and HHS with our federal partners, with our private sector collaborators, and with many of you in this room. It's truly been an all hands on deck effort and the work is just beginning. 

Tuesday, January 6, 2015

FHIR and the Future of Interoperability


There is growing interest in the health care information technology community in an emerging data exchange technology known as FHIR (pronounced “fire”). Last year we held a webinar on the topic with Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center; Keith Boone, Standards Geek at GE Healthcare; Janet Campbell, Software Developer at Epic; and Arien Malec, VP, Data Platform and Acquisition Tools at RelayHealth. Now I am following up with another great webinar (register for free HERE) with a great panel including Dr. Michael Hodgkins, CMIO of American Medical Association (AMA); Dr. Doug Fridsma, MD, CEO American Medical Informatics Association (AMIA); Dr. Charles Jaffe, CEO Health Level Seven (HL7); Jeffery Smith, Senior Director of Federal Affairs, College of Healthcare Information Management Executives (CHIME); and Mario Hyland, Senior Vice President AEGIS.net, Inc. You won't want to miss this...

Wednesday, December 31, 2014

[UPDATED] Unique Patient Identifiers and Congressional Appropriations

Unfortunately, I have discovered that the prohibition is still in effect. 


The language is slightly different than I am used to searching for but is included in the legislation HERE and copied below:
Sec. 510. None of the funds made available in this Act may be used to promulgate or adopt any final standard under section 1173(b) of the Social Security Act providing for, or providing for the assignment of, a unique health identifier for an individual (except in an individual's capacity as an employer or a health care provider), until legislation is enacted specifically approving the standard.
In March 2013 I submitted a petition to the White House suggesting that the President should ask Congress to no longer prohibit HHS from establishing standards for a unique patient identifier. Sadly, it did not get the required number of signatories (and could have been just ignored in any event) and is now removed from the WhiteHouse site, but the issue now suddenly seems to have been resolved, at least for the time being. 


In 1993 under President Clinton's health plan, the government would have issued "health security cards" to all Americans certifying their right to medical care, and the plans for a unique patient identifier were put in place. While the health reform did not make it into law at that time in 1996 Congress passed the Health Insurance Portability and Accountability Act of 1996 (HIPAA) [Public Law 104-191].  HIPAA included administrative simplification provisions that required HHS to “adopt national standards for electronic health care transactions” and “a standard unique health identifier for each individual, employer, health plan, and health care provider for use in the health care system” [PL 104-191]. HHS has since adopted unique identifiers for employers, health care providers, and is now in the process of adopting a unique health plan identifier, but has not adopted a standard unique identifier for individuals. 

On October 21, 1998, the 105th Congress passed Public Law 105-277 (an omnibus appropriations act for fiscal year 1999) that prohibited HHS from spending any funds to “promulgate or adopt any final standard…providing for, or providing for the assignment of, a unique health identifier for an individual…until legislation is enacted specifically approving the standard [Title V, Section 516 of PL 105-277].” 

For the past 15 years, despite calls from experts at RAND Corporation and the Healthcare Information and Management Systems Society (HIMSS), identifying the potential administrative cost savings and safety benefits associated with a unique patient identifier, Congress has maintained this prohibition. It appears there is no such prohibition in the Continuing Resolution Omnibus Appropriations Bill recently signed into law. (hat tip to Carl Bergman at EHRSelector)

While a unique patient identifier is no silver bullet it seems prudent for Congress to permit HHS to pursue its implementation, especially if such an identifier could increase administrative efficiencies and prevent medical errors due to incorrectly linked medical records.