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Doctors Press for Delay in Health IT Standards

By Melissa Attias, CQ Roll Call

July 21, 2015 -- A strong lobbying push by medical providers to delay minimum government standards for using electronic health records could influence a Senate panel's work to address widespread concerns about the effectiveness of the information systems.

The American Medical Association (AMA), American Hospital Association, and others want the Centers for Medicare and Medicaid Services (CMS) to hold off on finalizing a March proposal outlining criteria that providers must meet to receive payments and avoid penalties under what are known as "meaningful use" programs. The proposed rule would require providers serving Medicare and Medicaid recipients to begin the third and final stage of the effort in 2018.

The Alliance of Specialty Medicine, a coalition of groups representing specialty physicians, brought the issue to Capitol Hill last week. Its members asked lawmakers to push the agency for a delay. Spokesman Alex Valadka, a neurosurgeon, said in an emailed statement that the Alliance met with members and staff of the Senate Health, Education, Labor, and Pensions Committee and found them sympathetic to the concerns.

The panel has made electronic medical records a focus of hearings—another is scheduled for this week—and convened a working group earlier this year to identify problems that can be addressed legislatively or administratively. Recommendations could move as part of a medical innovation package that Chairman Lamar Alexander, R-Tenn., plans to release in the fall.

Asked if a delay of stage three is being considered in the working group, an Alexander aide wrote in an email that the committee is listening to input as it works to find solutions "that help make the failed promise of electronic health records something that physicians and providers look forward to instead of something they endure."

The House’s so-called 21st Century Cures bill (HR 6), which may ultimately be combined with the Senate innovation package, included language that aims to improve the interoperability of electronic health records rather than delay the meaningful use requirements. The measure passed the House earlier this month in a 344-77 vote.

Some House members still want to respond to concerns about the incentive programs. Rep. Renee Ellmers, R-N.C., is expected to introduce legislation next week that would delay the release of the final rule governing the third stage of the program until at least 2017, according to an aide. The bill is also anticipated to prescribe a 90-day reporting period regardless of the stage, expand a hardship exemption for providers that do not routinely interact with patients and address reporting requirements and the interoperability of state vendor products.

Provider Complaints

Although providers typically say they support the broad goals of the meaningful use programs, which were created in the 2009 stimulus package (PL 111-5), they maintain the efforts are being implemented in an unworkable fashion.

In an issue brief, the Alliance of Specialty Medicine said many members are struggling to meet the requirements because the measures aren’t relevant to specialists and their unique patient populations. The requirements in the stage three proposal include measures and thresholds that will be "virtually impossible" for specialists to meet, the coalitions says, adding that it should be delayed until a majority of providers are successful in earlier stages and CMS has studied participation barriers.

Only about half of eligible doctors participate in the incentive programs, and a small fraction have satisfied stage two, according to the Alliance brief.

At a town hall meeting last week in Atlanta, AMA President Steven J. Stack said the influential doctors' lobby would use anecdotes about doctors' experiences with the programs to communicate with the legislative and executive branches. Physicians at the event said their electronic health records systems have slowed down their productivity while requiring extra hours of work.

House Budget Chairman Tom Price, an orthopedic surgeon, attended the meeting and spoke briefly about the meaningful use requirements, maintaining that he thinks "we’re on the path to an unmeaningful and oftentimes useless product." But he also pointed to the successful replacement of Medicare’s physician payment formula in April (PL 114-10) as a reason for hope, noting that no one in the room—not even Price himself—initially believed it would be repealed this year.

"That happened because of your engagement, your involvement, the participation of state medical societies across this country and the participation of the AMA," said the Georgia Republican. "I want you to always remember that there is a light at the end of the tunnel and it isn’t necessarily an oncoming train."

Stack said the AMA thinks the administration should "pause" stage three of the meaningful use program so that it lines up with new payment delivery models and rulemaking can occur as other rules for a new performance-based incentive program are set up under the physician payment law.

Shawn Martin, vice president of advocacy and practice advancement at the American Academy of Family Physicians (AAFP), said in a blog post earlier this month that his organization has called for a delay in stage three to align the requirements with those in the new law. He also said the AAFP will be launching an advocacy campaign to delay the penalties for the second and third stages so that improvements can be achieved at a time when providers are not facing cuts.

In a letter responding to the stage three proposal, American Hospital Association Executive Vice President Rick Pollack urged CMS to hold off on finalizing the rule, citing insufficient experience with stage two of meaningful use. "Instead, the agency should evaluate the experience in Stage 2 while accelerating the availability of mature standards and the infrastructure needed for efficient and effective health information exchange," he wrote.

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