HHS Announces 2013 HIT Agenda Without Mention of Cuts

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Got an idea for how to accomplish the enormous job of speeding the nation-wide adoption of electronic health records that actually can share data (interoperability) without spending any extra money? Health and Human Services (HHS) is all ears.

As part of the agency’s announcement of its 2013 Health IT agenda, it also issued a Centers for Medicare and Medicaid Services (CMS) request for information (RFI) on how CMS and the Office of the National Coordinator (ONC) for Health IT can use the regulatory and reimbursement tools they have to create economic incentives for health care providers to adopt EHR systems and then share data on individual patients. Stakeholder have until April 21 to comment.

At the current Radiology Business Journal cover story “Solving the Image Sharing Dilemma” makes clear, just in radiology, working out who should pay the bill to set image sharing in motion is a major issue. Read more here...The CMS request for information outlines the problem for all of health care this way:

With fee-for-service reimbursement and other business motivations often being the stronger influencer of provider behavior, both providers and their vendors do not yet have a business imperative to share person level health information across providers and settings of care.

Because of the Federal budget deficit and the mandatory across-the-board budget cuts (the sequester) that began to roll out this month, CMS and the ONC are in no position to jump in and create that “business imperative” with additional Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs payments directly to providers.

As things currently stand, the current Medicare (but not Medicaid) EHR incentive payments may be 2% less than promised because they could be subject to the across-the-board Medicare reimbursement cut in the sequester. In addition, national health IT coordinator Farzad Mostashari, MD, told Health care Finance News yesterday, that the ONC’s budget will be cut 5% (roughly $3 million) under the sequester, with the majority of cuts being made in contracts. No employees will be furloughed.

That leaves CMS with tools like manipulating payment models to reward quality, efficiency and safety through better care coordination of care. This includes models like accountable care organizations (ACOs), bundled payments, health and medical homes, and rewarding reductions in hospital readmission rates. The RFI discusses several potential new policies and ideas along these lines.

"The 2014 standards for electronic health records create the technical capacity for providers to be able to share information with each other and with the patient," Mostashari said in the release. "Through the RFI, we are interested in hearing about policies that could provide an even greater business case for such information sharing."

Read the RFI for details on how to submit your comments.


The Top 5: HHS’s 2013 Health IT Priorities

Making no mention of budget constraints, HHS promises to:

  1. “Set aggressive goals for 2013,” including getting half of all physician offices to adopt EHR systems and 80 percent of eligible hospitals receiving meaningful use incentive payments by the end of 2013. 
  2. Increase emphasis on interoperability of EHR systems -- an issue Republican legislators began hammering them on last year.
  3. Get patients more involved in using personal health record systems by promoting initiatives like Medicare’s Blue Button that simplify accessing and using such systems.
  4. Move forward with Meaningful Use Stage 2.
  5. Make sure EHR systems don’t increase Medicare costs through problems with the integrity of the program -- like the systematic up-coding the New York Times and others reported last year. HHS promises greater use of extensive medical reviews and Comparative Billing reports to spot providers that may be “gaming” the system.