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Mostashari Leaving This Fall as Health IT Coordinator

August 6, 2013 -- Farzad Mostashari, the Obama administration’s driving force behind the move to convince providers to adopt electronic medical records, is stepping down as National Coordinator for Health Information Technology this fall.

Mostashari will continue to serve in his post during the search for his successor, Health and Human Services (HHS) Secretary Kathleen Sebelius said in an email message Tuesday to agency staff. He has been the national coordinator for the past two years.

“It is difficult for me to announce that I am leaving,” Mostashari said in his own email to staff members at the Office of the National Coordinator (ONC). Before being named coordinator, Mostashari was deputy coordinator for two years. “I don’t know what I will be doing after I leave public service, but be assured that I will be by your side as we continue to battle for health care transformation, cheering you on.”

The bubbly, bow-tie-wearing IT chief has been an energetic advocate of Medicare and Medicaid “meaningful use” payments and is credited with rapidly spreading the adoption of health IT. More recently, providers have urged lawmakers to slow down the program as it enters its “stage two,” with regulations designed to foster the exchange of medical data on individual patients between hospitals, doctors and other providers.

Mostashari’s “expertise, enthusiasm and commitment to innovation and health IT will surely be missed,” Sebelius said in her email. She added that his “critical work has not only brought about important improvements in the business of health care, but also has helped providers better coordinate care, which can improve patients’ health while saving money at the same time.”

Mostashari brought to the post a physician’s perspective and first-hand knowledge of the difficulty of adopting IT from his work in New York City where he encouraged primary care providers to adopt electronic records. Among the obstacles to wider IT adoption is the need for providers to adopt systems certified for 2014. “There are formidable challenges still ahead for our community, and for ONC. But none more difficult than what we have already accomplished,” he said.

He noted that the groundwork has been laid for patients to see their own medical records. “Over the next 12 months we will see a great democratization of health information as individuals become empowered to download their own health information” from providers, he said.

“His actions have helped ensure that consumers get the return they deserve for their investment in health IT, as well as access to the secure tools they need to be actively engaged in their health,” Debra L. Ness, president of the National Partnership for Women and Families, said in a statement.

Competing Pressures for Successor
Whomever succeeds Mostashari will face a push by purchasers and insurers to move faster toward data exchange, or “interoperability.” At the same time, the new coordinator will get opposing pressure from hospitals and doctors to move more slowly to interoperable systems that talk to each other.

What may be difficult to duplicate is Mostashari’s vigorous advocacy. “He brought a breadth of technology expertise to the department and, perhaps just as important, brought a great deal of energy,” said Dan Elling, a former GOP aide on the House Ways and Means Committee who now is lobbyist with the law firm Alston and Bird. “He is an excellent promoter of the value of widespread health IT adoption.”

But House Republicans grumbled about the way HHS was implementing the second stage of the three stages of rulemaking that makes up the meaningful use program, which was set in motion under the economic stimulus law (PL 111-5).

“In 2009, when the so-called stimulus law was being debated in Congress, Republicans expressed support for efforts to achieve interoperable health information technology systems,” GOP leaders of the Energy and Commerce and Ways and Means Committee wrote to Sebelius on Oct. 4, 2012. “However, we warned that failure to set a date certain for interoperable standards would put as much as $35 billion in Medicare and taxpayer funds in the hands of providers who purchase and use EHR systems that are not interoperable.”

The lawmakers complained that Stage Two eliminated a Stage One requirement that providers test the ability of their IT systems to exchange information with that of other providers. They also objected that Stage Two only required a provider to electronically transmit to another provider a summary of a medical visit for 10 percent of his or her patients. “We urge you to immediately suspend the distribution of incentive payments until your agency promulgates universal interoperable standards,” the letter said.

Meanwhile, GOP senators including John Thune of Wyoming, Michael B. Enzi of Wyoming and Patrick J. Toomey of Pennsylvania have also questioned whether health IT is leading to more ordering of tests and “upcoding” to bill for more complex care.

Mostashari’s supporters note that medical records and patient data can’t be transmitted electronically until all providers have health IT systems. Rapid and widespread IT adoption has happened under his tenure, they say, though much work remains before all providers, particularly smaller hospitals and physician practices, have the systems.

At a July 24 hearing before the Senate Finance Committee, providers said that in many instances they are still struggling to meet Stage One requirements and urged that they be given more time before those for interoperability in Stage Two kick in. Witnesses urged that the deadline for Stage 2 implementation be moved back from Oct. 1, 2014 to Oct. 1, 2015. But Senate Finance Committee Chairman Max Baucus, D-Mont., gave no sign he favored changing the current deadlines for the stages HHS has set under Mostashari.

Joel White, executive director of the Health IT Now coalition, said Mostashari “did a very good job of pumping up the adoption numbers and ensuring that providers were paid incentives quickly. When you take a look at the adoption rates, the latest numbers are something like 80 percent of hospitals and 50 percent of ambulatory providers” are now getting incentive payments because they’ve purchased systems. “That’s huge considering where we were three years ago.

“Farzad really ushered in the age of adoption of electronic health records,” White added and did an “outstanding” job in that regard. “The next person is going to have to solve the bigger riddle, which is how do we make sure everything is connected. What are people using these things for? The answer is to make Medicare and Medicaid more efficient. Are we there yet? Not by a long stretch. We have tons of work to do on interoperability. I wish he had done more on interoperability, but he pushed I think as hard as he could.”

John Reichard can be reached at [email protected].

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