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Healthcare Reform Update: Congressional Efforts Now Focused on Passage of Healthcare Reform Prior to State of the Union

January 8, 2010

Congressional Affairs

House and Senate Negotiate on Final Healthcare Reform Legislation
After passage of the Senate’s healthcare reform bill on Christmas Eve, it became clearer this week that Democrats on Capitol Hill would work to bypass a formal Conference Committee to merge the House and Senate healthcare reform bills. By forfeiting a typical Conference Committee of leadership from both houses, Democrats could avoid procedural hurdles that could pose risks to completion of a final bill, such as the appointment of members to the Conference Committee. Democrats in Congress engaged in negotiations this week, along with White House Officials. Speaker of the House Nancy Pelosi (D-CA) communicated that Congressional Democrats were close to an agreement but are still working to find solutions to many of the sticking points between the bills, such as the public option and the use of federal funds for abortions. Democratic leadership is working to pass a final bill prior to the President’s State of the Union address, which at this time is not scheduled. The State of the Union Address usually takes place at the end of January or early February, prior to release of a budget for the coming year.

Dodd and Dorgan Announce Plans to Retire
Starting off the new year, two leaders in the Democratic Party announced their plans not to seek re-election in 2010. Senator Chris Dodd (D-CT), who stepped in to lead the Senate Health, Education, Labor, and Pensions (HELP) Committee’s healthcare reform efforts during the illness of Senator Edward Kennedy (D-MA), announced his plans to not seek re-election in 2010, citing predictions of a tough campaign in November. In addition, Chair of the Democratic Policy Committee (DPC), Senator Byron Dorgan (D-ND), announced his retirement due to a desire to pursue other interests. Democrats currently have a 60-seat Senate majority.

Federal Affairs

CMS Releases Regulations
As highlighted last week, the Centers for Medicare and Medicaid Services released a Notice of Proposed Rulemaking for the Electronic Health Record Incentive Program for Medicare and Medicaid which defines “Meaningful Use of an Electronic Health Record.” The Office of the National Coordinator also released an interim final rule on the Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology. Upon release, the two regulations were described by Dr. David Blumenthal, National Coordinator for Health Information Technology, as enabling the transformation of the health system to "improve health care quality, efficiency, equity, and safety through the use of health information technology (HIT), while providing the foundation for continued, measurable improvement in our nation's health."  Public comments on both the proposed rule and the interim final rule are due to the federal government within 60 days of the publication of each rule in the Federal Register, January 13, 2010.  The third regulatory release on an interim final rule describing an HHS Certification Process is expected to be released by ONC before the end of the month.

For continuously updated information and analysis, and the opportunity to share your comments, please visit the HIMSS webpage.  And to learn even more, sign up for HIMSS’ ARRA Webinar Series on Meaningful Use and Certification Criteria, FREE for HIMSS members.  Join top leaders as they bring you the most relevant, up-to-date information you need today to take advantage of ARRA funding tomorrow.

The Medicare and Medicaid Incentive Payment Programs are designed as a three-stage effort:

Stage I – Electronic capture of health information in a coded format; tracking key clinical conditions and communicating outcomes for care coordinating; implementing clinical decision support tools to facilitate disease and medication management; and reporting outcomes for public health purposes.
Stage II – Expands on stage I.  Encourages the use of health IT to enhance computerized provider order entry; transitions in care; electronic transmission of diagnostic test results; and, research.
Stage III – Expands on stage II.  Promotes improvements to quality and safety; focuses on clinical decision support at a national level by encouraging patient access and involvement; and, improved population health data.

Preliminary Review of Key Points:

  • EHR Incentive Program
    • Stage 1 Meaningful Use consists of 25 measures; 17 metrics will require attestation by the provider, while eight will require information being submitted by the provider.
    • Computerized Provider Order Entry (CPOE) required in Stage 1 (10% hospitals; 80% for eligible providers)
    • Robust clinical quality measures for eligible professionals (EPs) and hospitals are delineated.
    • Requires patients be provided with an electronic copy of test results, problem lists, medication lists and discharge summary upon request.
    • Hospitals can participate in both Medicare and Medicaid incentives, if eligible by volume.
    • Hospitals and EPs must implement five clinical decision support rules relevant to clinical quality metrics.
    • Hospitals and EPs able to use an attestation methodology to submit summary information to CMS in 2011.  Expect a formalized process from HHS by 2012.
    • Hospitals and EPs have a 90-day minimum reporting period in the first year to qualify as a meaningful user.  Subsequent years require full year reporting
  • In physician practices, key information system applications needed to meet the definition of a qualified EHR are:
    • Clinical Data Repository – store, retrieve, and manage medications and laboratory and radiology results.
    • Clinical Documentation – provide appropriate referrals, problem list, current medication list.
    • Clinical Decision Support – implement drug-drug, drug-allergy, and drug-formulary checks.
    • CPOE required in the areas of medications, laboratories, radiology/imaging, and provider referrals.
    • Requires electronic generation and transmission of permissible prescriptions.
    • Financial Information Systems – ability to check insurance eligibility and submit claims electronically.
    • Patient Communication – ability to electronically generate reminders, provide test results, problem lists, and immunizations.
  • In hospitals, the key applications needed to meet the definition of a qualified EHR are:
    • Clinical Data Repository – store, retrieve, and management laboratory and radiology results.
    • Clinical Documentation – nursing and physician in the areas of discharge, transfer, care coordination, problem list, demographic capture, vital signs and BMI, smoking status (for patients 13 years and older); calculate and electronically display quality measure results.
    • CPOE in the areas of medications, laboratories, radiology/imaging, blood bank, physical therapy, occupational therapy, respiratory therapy, rehabilitation therapy, dialysis, provider consults, and discharge/transfer.
    • Medication administration for alerts at the point-of-care to accomplish real time drug-drug, drug-allergy, and drug-formulary checks, and to maintain an active medication list.
    • Clinical Decision Support – implement the five automated, clinical rules.
    • Financial Information Systems – ability to check insurance eligibility and electronically submit claims.
    • Patient Communication – create an electronic copy of a patient's clinical information upon request. Provide copy of discharge instructions and procedures at time of discharge, upon request.

HIMSS’ initial assessment is the regulations are moving the healthcare community aggressively toward adoption of EHRs and other health IT solutions.  HIMSS is committed to providing our membership with the best analysis of these rules. The HIMSS website  has a series of tools designed to summarize and provide analysis of each rule HIMSS will be constantly providing updates to these tools, so continue to check back to get the latest analysis. Also, there is a comment section that provides you an opportunity to ask questions about and discuss the ramifications of each rule.

ONC Moves Forward with Workforce Initiatives
In other ARRA activities, ONC has initiated several programs to ensure the Nationwide Health Information Network (NHIN) has a workforce to support it.  This week, ONC held two national teleconferences designed to overview two benchmark HIT workforce initiatives. The first, the Community College Consortia to Educate Health Information Technology Professionals in Health Care Program is designed to rapidly create HIT academic programs at Community Colleges or expand existing ones. By the end of the two-year project period, all of the Community Colleges participating in the program will have established training programs with the capacity to train at least 10,500 students annually to be part of the HIT workforce. The curriculum of these programs must be completed over an intense six month period, training students to go into one of six health IT fields:  Practice workflow and information management redesign specialists, Clinician/practitioner consultants, Implementation support specialists, Implementation manager, Technical/software support staff, and Trainers. The program will award 5 grants totaling $70 million. Applications are January 22, 2010.

ONC will be hosting a second Technical Assistance call for potential applicants, next Friday, January 15th from 3:00 PM to 4:00 PM EST.  HIMSS Members can Dial into 888-769-8716 and use the passcode 6123844 to listen to the call.

The second ONC HIT workforce initiative focuses on four year colleges and universities. The Program of Assistance for University Based Training will provide $34 million in grant funding to accredited colleges and universities to create non-thesis masters and certification programs for health IT workforce professionals that can be completed in one year in one of six Health IT fields: Clinician/Public Health Leader, Health Information Management and Health Information Exchange Specialist, Health Information Privacy and Security Specialist, Research and Development Scientist, Programmers and Software Engineers, and Health IT Sub-Specialists. Universities can get a maximum award of $4 million, with consortiums eligible for up to a $6 million award. Applications are due to ONC no later than January 25, 2010.

New Meaningful Assessment Tool
Members of HIMSS Management Engineers and Process Improvement Community have developed an interactive Meaningful Use Stage 1 Hospital Assessment Tool for hospital providers.   The tool enables hospitals to track their compliance with meaningful use requirements by process group and providing the user with score sheets and graphical representations of their progress by the year and project life cycle.  The tool is located on the HIMSS Meaningful Use and Certification website, under “Tools and Resources.”  

CMS Awards Funds to Pennsylvania and Tennessee
The Centers for Medicare & Medicaid Services (CMS) has announced that the Medicaid programs in Pennsylvania and Tennessee will receive federal matching funds to begin planning to implement the electronic health record (EHR) incentive program established by the American Recovery and Reinvestment Act (ARRA). Tennessee will receive approximately $2.7 million in federal matching funds, and Pennsylvania $1.42 million.  The states are expected to use the funds to analyze current health IT activities, gather information on existing barriers to use of EHRs, study provider eligibility for EHR incentive payments, and create state Medicaid health IT plans.

CMS Plans EHR Tests
CMS plans to test the ability of Electronic Health Records (EHRs) to submit clinical quality data for hospital quality measures on Emergency Department Throughput and Stroke and Venous Thromboembolism, and to test its technical ability to accept these data from EHRs.  EHR vendors/hospitals that wish to participate may self-nominate by sending a letter of interest to IP_EHR_Testing@cms.hhs.gov, or to "RHQDAPU Program IT Testing Nomination," Centers for Medicare and Medicaid Services, Office of Clinical Standards and Quality, Quality Measurement and Health Assessment Group, 7500 Security Boulevard, Mail Stop S3-02-01, Baltimore, MD 21244-8532. The deadline for receipt of self-nomination letters has been extended to 6 pm EST on February 1, 2010.

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