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Groups Urge Easier Standard for Proposed Incentive to Promote Health Information Technology

By John Reichard, CQ HealthBeat Editor

March 15, 2010 -- Doctors and hospitals are urging the Obama administration to ease its proposed standard to qualify for Medicare and Medicaid bonus payments for using health information technology. Too few doctors would be able to meet the standard, frustrating efforts under economic stimulus legislation to spur adoption of "health IT," providers warn.

In response to the complaints, Health and Human Services Secretary Kathleen Sebelius said that the administration doesn't want to go too easy. "A lot of American medical practices are seriously behind what's going on in other parts of the world," she said Monday.

"We are trying to get physicians on the escalator toward meaningful use, and we want to set the first step at the right level," said David Blumenthal, the head of the Office of the National Coordinator for Health Information Technology. Blumenthal said he couldn't comment specifically on the provider reactions because of the pending rule-making proceeding.

Sebelius and Blumenthal spoke in a telephone news briefing to announce $162 million in grants to 16 states to promote the development of statewide systems to exchange health data. The systems would exchange medical data among doctors, hospitals, insurers, employers and other participants in the health care system.

The American Medical Association said in comments Monday that the proposed rule to promote the meaningful use of health IT should drop an "'all or nothing' approach and require physicians to meet five of the 25 proposed objectives and measures instead of all 25." It said the final version of the rule should "eliminate the objectives and measures that don't directly apply" to the adoption of electronic health records, "such as checking insurance eligibility electronically."

In addition, it should "revise the definition of meaningful use for certain hospital-based physicians to broaden eligibility for the federal incentive programs," the American Medical Association said. It also recommended that the final rule should "reduce the number of quality measure reporting requirements and allow physicians to identify only three clinically relevant measures."

Studies of adoption of electronic health records (EHRs) "clearly show that it takes more time for smaller practices to adopt and implement EHRs because they have fewer resources and support," the American Medical Association said. "Aggressive timelines and criteria during the initial stage of the incentive program will only serve to undermine this effort."

The Federation of American Hospitals, which represents for-profit hospitals, agreed that the all-or-nothing provision should be eased. It also said the Health and Human Services Department (HHS) should revisit its regulatory timetable for adoption of health information technology because of the slower-than-expected launch of a program to certify that technology is "interoperable" — that it meets standards allowing it to be used with other providers' systems.

To qualify for the Medicare and Medicaid bonus payments, doctors and hospitals have to use IT certified as interoperable.

"This delay has lead to uncertainty in the marketplace and hesitation on the part of providers to make a substantial capital investment in products that may prove not to be a pathway to achieving meaningful use," the federation said in a March 9 comment letter.

The federation said it wasn't calling for an end to the start of penalties in 2015 for failing to make meaningful use of technology, but it added that the deadline for full implementation should be moved back to 2017.

The Medical Group Management Association has urged a one-year delay in the first stage of three proposed stages for adopting health IT. The proposed rule calls for the first stage to occur in 2011 and 2012; the association wants it to run through 2013.

HHS said in a news release that the $162 million in grants will help states develop plans that create non-proprietary data exchange systems meeting national standards. States play a critical role in the development of such systems, HHS said. Their development also will make it easier for providers to qualify for higher Medicare and Medicaid payments going to meaningful users of health IT, Blumenthal noted.

On Feb. 12, HHS announced $385 million in awards for the development of data exchanges. The latest grants close out funding for the data exchange development under the economic stimulus law.

Blumenthal declined to predict when the first state would have a data exchange system operating, but noted that Rhode Island is a pacesetter in this area.

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