By Rebecca Adams, CQ HealthBeat Associate Editor
July 20, 2010 -- When federal officials released final rules on July 13 governing how medical providers should use electronic records, they scaled back some requirements in an earlier proposal. They said they wanted to strike a balance and create goals that were ambitious but also realistic.
But some House Ways and Means Health Subcommittee Republicans made it clear in a hearing Tuesday that they thought the requirements had been eased too much.
The rules will provide hospitals and providers such as physicians with incentive payments if they create and use electronic health systems.
Republicans Wally Herger of California and Sam Johnson of Texas specifically questioned why the rules do not require providers to exchange electronic information in a secure way. Instead, officials would require providers only to test systems to see if they are capable of exchanging information during the first stage of the three-phase initiative.
David Blumenthal, the national coordinator for health information technology, responded that exchange systems are not ready to be deployed in all parts of the country. He said that providers should not be penalized if an exchange clearinghouse that must be used to trade information is not operating in an area or if hospitals and physicians have not set up an agreement on how to securely share data.
"It's not fair to individual physicians who are trying desperately to become meaningful users" of health information technology to require them to securely transmit data if the problems are "something they can't control," said Blumenthal.
He noted that the rule does move forward on exchanging information through such requirements as telling physicians to transmit more than 40 percent of prescriptions electronically.
Most importantly, Blumenthal said, the next two phases of the initiative will have more ambitious goals.
"In 2013, they have to be ready to exchange in a much more robust way," said Blumenthal, adding that the administration is "starting where we think industry is, but putting them on notice that they're going to have to move fairly rapidly."
The rules stem from the 2009 economic stimulus law (PL 111-5), which may provide as much as $27 billion in incentives over a decade in an effort to move the practice of medicine into the digital age. Eligible medical professionals such as physicians may receive as much as $44,000 under Medicare and $63,750 under Medicaid and hospitals may receive millions of dollars for meeting requirements in the rules to create and use health IT systems.
Blumenthal and Tony Trenkle, director of the office of e-health standards and services at the Centers for Medicare and Medicaid Services, repeatedly defended the regulations as an important step that encourages medical providers to make progress on electronic health systems without setting the bar unrealistically high.
The officials also heard complaints from lawmakers that the administration did not make one requested change. The regulations will treat hospital systems with more than one hospital as one provider, while some lawmakers and hospitals prefer that they be treated as separate hospitals.
Trenkle noted that officials "did hear from a large number of groups and organizations and members of Congress on this issue," but that what officials sought "to do in the final rule was be consistent with our payment policies" in Medicare. The administration officials said that they could be sued if they adopted a policy in the regulations that differed.
However, Democrat Earl Pomeroy of North Dakota said the outcome "was very disappointing" to lawmakers. "You'll probably be hearing more from us on this," he said.