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Hospitals, Consumers Give Cautious Thumbs Up to IT Proposal

By John Reichard, CQ HealthBeat Editor

February 27, 2012 -- Hospital and consumer groups for the most part reacted favorably last week to two Obama administration regulatory proposals to improve the quality and safety of medical treatment through more effective use of health information technology (IT).

Hospitals praised the long-awaited "stage two" proposed rules to spur "meaningful use" of IT for providing a flexible approach. Meanwhile, a consumer group said the stage two proposals will increase online patient access to their own medical data and ease e-mail communication with their doctors.

The so-called meaningful use regulatory program, established under the 2009 economic stimulus law (PL 111-5), requires providers to make increasingly sophisticated use of health IT over time in order to qualify for Medicare and Medicaid incentive payments. The program establishes three different stages of requirements in order to increase meaningful use of health IT. Eventually, providers will get lower reimbursements if they don't make such meaningful use.

Hospitals said that stage one initially demanded too much. The requirements were softened under the final rule.

In the new proposal, "there have been a lot of lessons learned" by the administration, said Samantha Burch, vice president of quality and health information technology at the Federation of American Hospitals. But hospitals also criticized proposed financial penalty provisions for those failing to use the technology. And they expressed concern about added requirements that providers report quality of care data.

Policy makers are counting on the technology to prevent medication and other treatment errors, spur use of the most effective treatment practices and eliminate duplicative medical tests of various kinds. They hope it will help bring Medicare and Medicaid costs under control. But the health system has a long way to go to adopt IT and use it effectively.

The administration issued two proposals: one by the Centers for Medicare and Medicaid Services (CMS) in which the agency spells out what providers must do to receive bonus payments in stage two; and the other by the Office of the National Coordinator for Health Information Technology at HHS defining standards and criteria for certified electronic health records (EHRs). Providers have to make meaningful use of certified records to get bonus payments.

Burch lauded the administration for proposing to give providers two years in each stage of meaningful use before they have to comply with a higher stage. Previously, industry feared that a provider might have as little as a year in one stage before having to meet the requirements of the next stage.

The proposal also makes clear that if a provider became a stage one health IT user in 2011, it has until Oct. 1, 2013, before having to meet stage two requirements. Previously, the administration was giving those providers only until Oct. 1, 2012, to comply with stage two. "That gives them a little breathing room," said Tom Leary, an official with the Healthcare Information and Management Systems Society. Leary added that some of the requirements to show meaningful use have been consolidated, making them less burdensome.

The HHS certification proposal would reduce costs for providers by clarifying that they do not have to purchase certain software modules, hospital lobbyists noted. Doctors and hospitals have some options over which information they must make available electronically. They can pick from a menu of requirements to meet.

Under current law, they have had to buy software to meet all the requirements. Thus hospitals have had to buy modules to provide data electronically to state agencies that aren't yet prepared to receive it, says Chantal Worzala, director of policy at the American Hospital Association. Under the proposal they would no longer have to do so if that's not how they chose to demonstrate meaningful use.

The CMS proposal also aims to spur the electronic exchange of information between providers, and between providers and their patients. That drew praise from consumer advocates.

The proposal "has the potential to advance the use of technology to coordinate care across providers," said Christine Bechtel, vice president of the National Partnership for Women and Families. So when a doctor refers a patient to another doctor outside her medical practice, for example, she must transmit electronically to the new provider a summary of the care her patient has received. The proposal requires that in at least 10 percent of the cases in which a patient is referred to a care setting not affiliated with the referring provider, the care summary must be transmitted electronically using "interoperable" computer systems that can communicate with each other.

Bechtel said that standards for electronic transmission of data to patients would be tightened to include timely access to lab results, a list of prescription drugs the patient is taking and demographic information.

"We are pleased that it will allow patients to send secure electronic messages to their doctors—that is long overdue," she said. However, she expressed fear that providers would try to "gut" proposed requirements that a fixed percentage of patients get their medical data electronically.

For their part, providers say CMS is premature in proposing electronic data transmission for an expanded set of clinical quality measures. Worzala said hospitals have had difficulty submitting such clinical data in phase one because CMS has been unclear about exactly what clinical information it wants or has asked for information not contained in electronic health records. "We think we need to fix what's broken" before expanding the set of measures, Worzala said.

Worzala added that a "a major concern" for hospitals is a part of the proposal that lowers payments in 2015 if providers are not "meaningful users" of health IT in 2013. Hospitals had thought that the penalties hinged on whether or not they are meaningful users in 2015. "We think it's inappropriate to accelerate it by two years," she said.

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