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Debate Heating Up Over CMS Payments for Health IT

By John Reichard, CQ HealthBeat Editor

May 2, 2012 -- The enforcement of federal rules written to prod doctors and hospitals to adopt health information technology (IT) is attracting wide scrutiny, with congressional auditors worried that Centers for Medicare and Medicaid  (CMS) officials are too lax and providers and their allies saying the requirements are too tough.

A Government Accountability Office report released this week says that the rules create a complex system of financial rewards and penalties for using the technology. That complexity increases the risk that CMS will make improper Medicare and Medicaid payments relating to health IT.

"CMS could take steps, beyond those already taken, to assess and mitigate the risk of improper payments and to improve program efficiency," said the report. GAO said, for example, it is "encouraging" that CMS has awarded contracts to evaluate how well states are adopting electronic health records in Medicaid. But the report complains about the lack of a CMS timeline to review the agency's audit strategy for the Medicare electronic health records program.

Temperature Rising

Meanwhile, hospitals and doctors are objecting to a CMS proposal that aims to increase the use of health IT to make care more efficient. But IT vendors and consumer groups are pushing back against provider objections. IT's promise won't be realized if CMS caves, they assert.

At issue is the CMS "stage two" proposal for "meaningful use" requirements, whose comment period ends May 7.

Stage one got many providers to buy IT systems and begin using them to record patient information and some data on clinical performance measures. But CMS wants providers to report data on more measures in stage two. It also wants to spur the ability of hospitals to exchange medical information with unaffiliated doctors' offices that use different IT systems. The idea is to create an "interoperable" system where different computer systems talk to one another and providers throughout a wide area can easily share medical data.

But stage two goals "may be too ambitious for some small or solo practice physicians to meet," said Rep. Renee Ellmers, R-N.C., chairwoman of the Small Business Subcommittee on Healthcare and Technology. She said that doctors are worried about Medicare payments reductions scheduled for 2015 for physicians who don't demonstrate meaningful use of health IT. "I urge you to allow hardship exemptions for very small practices," Ellmers said in a May l letter to CMS Acting Administrator Marilyn Tavenner.

Hospitals argue that the stage two rules imperil widespread adoption of health IT. "Taken as a whole, the proposed requirements for meeting stage two raise the bar too high and are not feasible for the majority of hospitals to achieve," the American Hospital Association (AHA) said in an April 30 letter to CMS.

The 68-page comment letter says when it comes to complying with meaningful use requirements, "the rushed timelines and complex regulatory requirements make the process difficult." Costs are large, it adds, estimating that "hospitals spent $57,000 a year per bed on IT in 2010."

However, patient advocacy groups are worried about AHA's power to pressure CMS to water down the regulations. "With the deadline looming, one of the powerhouses in the health care provider community has made public its displeasure with a number of the most robust and important patient-engagement criteria," said Christine Bechtel of the National Partnership for Women and Families, referring to the AHA letter. "In fact, leaders of this organization made their views known with such vehemence that their views should be characterized as hostility," Bechtel added.

She chided AHA for urging that hospitals be given more time to give patients web access to medical information relating to a hospital stay.
The stage two proposal says patients should have access to that information within 36 hours of being discharged. But Bechtel says AHA wants hospitals to have up to 30 days "for access to such basic, crucial and highly time-sensitive information as discharge instructions, medication lists, lab test results and care transition summaries."

She adds that "this is the very information that can help keep patients from being readmitted unnecessarily. No patient in this day and age should have to wait a full month for access to their own health information, which is vital to their ability to get and stay well."

Another concern relates to a proposed requirement that hospitals to be able to transmit electronically a summary-of-care record when a patient is transferred or referred to another provider that has an electronic health record system from a different vendor. At least 10 percent of summary-of-care record transmissions in these cases should be performed electronically with outside organizations that use different electronic health record systems, CMS is proposing.

AHA says this requirement would create an unreasonable burden because providers "would need to count transitions, track the organizational affiliations of the recipients, and track the vendors used by the recipients."

The Health IT Now coalition says this is one of the few provisions in the stage two proposal that would begin laying the groundwork for the widespread sharing of medical information, which is critical to achieving IT's potential for making care safer and more efficient, it adds.

"We believe these standards are achievable and that more must be done to promote the exchange of information to better coordinate patient care," said Joel White, executive director of the coalition. "We will encourage HHS to take steps in that direction."

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