- In the wake of discouraging reports highlighting the negative effects of strict federal regulation and EHR use, CMS has pushed administrative burden reduction to the top of its agenda.
In 2017, CMS Administrator Seema Verma introduced a new approach to quality metrics called Meaningful Measures and launched Patients Over Paperwork—a collaborative process for evaluating and streamlining regulations to increase clinical efficiency and improve the beneficiary experience.
Most recently, CMS released the 2019 Inpatient Prospective Payment Systems (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) proposed rule. The proposed rule rebrands the meaningful use program as “Promoting Interoperability” and introduces policies to make the program more flexible and less burdensome.
Overall, Verma said the proposed rule will save providers $75 million in costs and eliminate more than 2 million administrative hours in burden reduction over the next two years.
According to AHA Vice President for Health IT and Policy Operations Chantal Worzala, the new rule represents a step in the right direction.
“We’re certainly appreciative of the ways in which CMS is looking to introduce some flexibility into the meaningful use program,” Worzala told EHRIntelligence.com. “It’s a good idea to remove requirements that hold hospitals responsible for the actions of others. The shorter reporting periods are also helpful.”
American Academy of Family Physicians (AAFP) President Michael Munger, MD also stated his support for the federal agency’s decision to shorten the reporting period to 90-days.
Though the majority of AAFP members work in ambulatory practices, Munger said policies in the IPPS proposed rule that shorten the reporting period are an encouraging sign for physicians advocating for reduced regulatory burden.
“That 90-day period will really let practices focus and look across the continuum,” Munger told EHRIntelligence.com. “They’ll be able to innovate in the practice, deliver quality care, and deliver quality improvement projects without having that tedious task of having to go through the reporting aspect of it. That’s a very definite positive step.”
However, Worzala maintained that certain aspects of the proposed rule still miss the mark. Specifically, part of the IPPS proposed rule mandates that providers begin using 2015 edition certified EHR technology (CEHRT) by the 2019 reporting period.
“We are a bit concerned about whether or not the technology the 2015 edition certified EHR is actually going to be available in a way that allows for an orderly transition,” she said.
Worzala asserted the final rule is in need of some changes, but she and Munger agreed the recent CMS initiatives have been successful in narrowing the federal agency’s goals to only address the most pressing priorities.
The AHA and AAFP leaders both cited the decision to rebrand meaningful use as Promoting Interoperability as an especially positive step.
“Interoperability is the goal after all,” said Worzala. “Making sure that information is easily accessible to the people who need it when they need it to make important health or clinical decisions. From that point of view, a focus on interoperability makes a lot of sense. The Promoting Interoperability program as they now call it certainly signals what the priority of the administration is.”
"That 90-day period will really let practices focus and look across the continuum."
Similarly, the new MyHealthEData initiative spearheaded by the Trump Administration and supported by CMS, ONC, VA, and other federal agencies supports improved health data access.
“We love to see that patients have meaningful control of their data,” said Munger. “We also like anything that will put the focus on interoperability and really that information exchange between physicians and healthcare delivery systems. That’s the right direction.”
Worzala said she also supports the overarching goal of improving patient access to EHRs. However, she suggested the MyHealthEData initiative’s focus on using the Fast Healthcare Interoperability Resources (FHIR) standard to proliferate application programming interface (API) development might be premature.
“It’s the right direction to go — there’s tremendous promise from going down that road,” said Worzala. “But we’ll note one thing — the FHIR standard is a draft standard and it’s not scheduled to be finalized until the end of this year. We want to make sure that everyone is using a finalized standard in the same way, because without that actually you won’t really get information exchange.”
“So that’s part of where our concerns about whether or not the technology will be ready to support the requirements,” she added.
The concern that FHIR standards may not be mature enough for widespread implementation also ties into AHA’s concern about the viability of IPPS policies supporting widespread 2015 edition CEHRT implementation.
While many industry stakeholders would like to see widespread use of the FHIR standard in API development, 2015 edition CEHRT criteria makes no mention of FHIR. The certification criteria only states that 2015 edition CEHRT should support the use of an API.
“We might actually end up with proprietary APIs, which actually get in the way of standards-based information sharing,” Worzala said. “We do have this question of, what’s the standard? And is everyone going to use it the same way?”
The lack of alignment between ONC 2015 edition CEHRT criteria and policies in MyHealthEData about innovation could further complicate efforts to streamline interoperability.
Munger suggested the MyHealthEData initiative will need to be fleshed out in more detail before patients and providers can expect to see positive changes in the way health data is shared.
“It’s important that we make sure we focus not so much on the data in the exchange but how and when the data is exchanged,” emphasized Munger. “We need to make sure that’s front and center, as opposed to worrying so much about the format and the mass volume and all of the boxes being checked. You want to make sure you have the ability to access key parts of the data.”
“Test results and things along those lines,” he continued. “That’s really what’s gonna enhance patient care. It’s going to require more work, but it’s a very positive first step.”
As a physician, Munger also pointed out that much of the discussion among stakeholders about health data exchange puts the onus on healthcare organizations to improve interoperability. Physician practices are not the ones in charge of advancing health data exchange and standardization, he said.
“Right now, the responsibility for the adoption of interoperable EHR systems falls to the physician practices,” said Munger. “We need just a basic shift to say, let’s put the creation of and standardization of the EHR systems on the vendors. It shouldn’t be on the physicians. For me, that should be an overarching principle moving forward.”
Munger also stressed the need for policymakers to implement strict regulations surrounding information blocking.
“I know that we have information blocking penalties,” said Munger. “But now let’s see appropriate enforcement. Let’s see that that’s getting carried through so we can really start to see good meaningful interoperability.”
Former Vice President Joe Biden similarly emphasized the need to implement strict information blocking regulations during a March Fortune editorial. He stated the MyHealthEData initiative lacks specific action steps to improve EHR patient data access.
“I know that we have information blocking penalties. But now let’s see appropriate enforcement."
Biden recommended policymakers include legislation in forthcoming information blocking rules mandating that healthcare organizations enable complete EHR patient access within 24 hours of a request.
According to a recently released Unified Agenda from the Office of Information and Regulatory Affairs, stakeholders can expect to see new information blocking regulations in September.
Ultimately, AAFP and AHA want to see CMS and other regulatory bodies maintain a focus on fostering simplicity and alignment.
“We’d like to see elimination of the current E/M documentation guidelines,” said Munger. “All those bullets for billing.”
CMS recently simplified clinical documentation guidelines to allow teaching physicians to verify medical student documentation in a patient’s evaluation and management (E/M) code services. Munger explained that the federal agency should work to eliminate or streamline these arduous clinical documentation guidelines further.
“The need to put together a two-and-a-half page note to justify your level of coding — that really does detract from the overall patient experience. And you spend so much time going through that it takes you away from the patient,” he said.
Despite the remaining areas of federal regulation in need of refinement, AAFP and AHA are supportive of the general direction the administration is heading. An overall focus on outcomes rather than process will shift the focus firmly on quality improvement rather than volume of services.
“We’re definitely moving forward,” concluded Munger. “I see that the focus is there.”