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Medicare Health IT Proposal in Doctor Pay Rule Wins Early Praise

By Kerry Young, CQ Roll Call

April 28, 2016 -- Medicare officials are winning praise for their bid to change rules for doctors' use of electronic health records (EHR) as part of a draft proposal released late Wednesday.

The Centers for Medicare and Medicaid Services (CMS) outlined a new approach to judge how well doctors use electronic health records. The proposal is accompanied by plans to prevent technology organizations from improperly blocking the flow of information among medical professionals.

The proposal is in a draft rule to implement a congressional overhaul (PL 114-10) affecting payments for many doctors. CMS' current meaningful use approach presents a high hurdle for many doctors, whose Medicare pay can be dinged for failing to meet a full set of goals set by the agency. Penalties start at 1 percent of reimbursement. Lawmakers including Senate Health, Education, Labors and Pensions Chairman Lamar Alexander, R-Tenn., have been quick to note that only about 12 percent of eligible doctors have been able to meet an advanced threshold of the meaningful use requirements.

The draft physician pay rule released Wednesday by CMS calls for a "new, more flexible scoring methodology," and a "more holistic approach to health IT." The agency said it is seeking comments on what kinds of measures to include in a new set of metrics, which would be called the advancing care information performance category. This will be part of the new merit-based incentive payment system Medicare is developing for doctors' pay.

"While we are still reviewing the proposed rule, we are pleased to see provisions support two of our main priorities: leveraging technology to deliver high quality health care at a lower cost and once and for all ending the practice of information blocking in a program built on the promise of information exchange," said Health IT Now, a coalition with members including insurance giant Aetna Inc., tech firms Oracle Corp. and Intel Corp., and medical specialty groups, such as the National Alliance on Mental Illness.

Bob Doherty, senior vice president for governmental affairs and public policy at the American College of Physicians, tweeted that the "proposed rule seems to be responsive to pleas to simplify reporting" through electronic health records. The American Medical Association said in a statement that "it appears that CMS has made significant improvements by recasting the EHR Meaningful Use program and by reducing quality reporting burdens."

Andy Slavitt, the acting CMS administrator, has been frank about the shortcomings of the meaningful use approach. He called on the health information technology industry and investors at a January conference to aid CMS in shaping a new approach, saying that the agency has lost the "hearts and minds" of doctors with its meaningful use program. It's often jokingly called "meaningless abuse" in medical circles, with doctors and other health professionals quick to name what they consider pointless information they must log about their patients. 

On a call with reporters Wednesday, Slavitt said CMS held focus groups meeting in eight cities about how to change the rules on electronic health records. Doctors told CMS, for example, that they were frustrated that they couldn't use electronic health records for many practical purposes, such as tracking how their patients fare when hospitalized, Slavitt said. Another common complaint was that the current rules lock doctors into certain products, making it tough to switch to new technologies that might suit them better.

"What they wanted was more flexibility and greater control," Slavitt said.

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