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Saturday, April 6, 2013

Weekend update

I'm sure I'll think of something... hmmm... first, well,


Maybe I'm missing something. Maybe there's an effective Top Secret Zero Dark Thirty REC Advocacy Stealth Campaign going on behind the scenes on The Hill and within the halls of the administration via which to render and waterboard the policymakers until they come across with more cash.

I rather doubt it.



One little scrap:
Will pathologists be exempt from meaningful use penalties?
Jennifer Bresnick, EHR Intelligence

In a continuing effort to refine the EHR Incentive Program and recognize the unique needs of certain specialists, Rep. Tom Price (R-Ga) and Rep. Ron Kind (D-Wis) have introduced a bill that would exempt pathologists from having to meet meaningful use requirements and its associated penalties, due to the fact that most pathologists do not interact with patients on a regular basis and don’t have use for a core EHR as envisioned by CMS during its establishment of meaningful use criteria.

“Current regulations implementing electronic health record meaningful use standards largely reflect physician office-based practices and thus, are not applicable to the practice of pathology and laboratory medicine,” the bill asserts.  While many pathologists and laboratories do have electronic systems that interface with EHRs, their work in analyzing patient specimens and generating test results doesn’t match with the current meaningful use requirements. “This lack of alignment between regulation and pathology practice makes it nearly impossible for pathologists to satisfy meaningful use standards, putting them at risk for payment penalties under Medicare.”...

Well, YEAH? That should be a no-brainer. The story continues:
Many specialists have complained that meaningful use is too focused on primary care practice and hospitals, preventing specialists from attesting and receiving government incentive funds...
That's rich; RUV px jockeys earning perhaps twice what their PPCP counterparts make whining about not getting to also sidle up and swill at the ONC trough (all while otherwise bad-mouthing the feds at every turn). "Too focused on primary care"? You guys are just now getting around to bitching about that? This initiative is four years old. It's not exactly been a closely held secret.

OK. There are -- what? -- some 80 medical specialties. Should we have Meaningful Use criteria tailored to each of them, just so they too can lap up some of the gravy?

The long answer is no. But, they should not then be subjected to reimbursement penalties --  say, should they at least have adopted certified EHR technology.

Medscape Medical News
Bill Would Exempt Retirement-Age Physicians From EHR Penalty

Robert Lowes

Physicians near retirement wouldn't suffer a Medicare pay cut for failing to adopt an electronic health record (EHRs) system, and soloists would get a 3-year hiatus from this penalty under a bill introduced last month by Rep. Diane Black (R-TN).

The measure, which Black had introduced in the previous session of Congress, also would give specialists some breaks in earning bonuses and avoiding penalties in the incentive program, designed to promote "meaningful use" of EHRs for the sake of improved patient care and lower costs.

The Centers for Medicare & Medicaid Services (CMS) has paid bonuses under Medicare and Medicaid since 2011 to physicians who meet strictly defined measures of EHR use when it comes to prescribing, drug interaction alerts, medication lists, and the like. In 2015, the incentive program enters its penalty phase. That year, physicians who fall short of meaningful use standards in a prior reporting period will experience a 1% Medicare pay cut. There are no Medicaid penalties in the incentive program....
I will, of course, monitor these and any other legislative proposals that surface. I don't see any major mods to the MU program getting any traction, but it could die a slow death of a thousand pinpricks.

ONC Awards HIE Interoperability Work

The Office of the National Coordinator of Health IT (ONC) has awarded cooperative agreements involving cash grants to two nonprofit entities that are working toward the national goal of interoperability among health IT systems. The agreements are the first two to be struck under ONC's new Exemplar HIE Governance Program.

ONC is giving $285,000 to DirectTrust, a trade association that is creating a security and trust framework for directed exchanges of information. The office also provided $205,000 to the EHR/HIE Interoperability Work Group (IWG), led by the New York eHealth Collaborative (NYec), which is developing plug-and-play interoperability for both directed exchange and query-based exchange. A directed exchange setup enables secure point-to-point electronic exchanges of clinical data between care providers. Query-based exchange capability lets providers find or request data from other providers...
"a trade association that is creating a security and trust framework"?

Well, OK.

...Although the amounts that ONC awarded to the two organizations are not large, their official recognition shows the government's support for them. It also gives ONC sway in directing the activities of the organizations and aligning them with ONC's goals in the area of HIE governance...
Well, OK.

I chafe at the term "governance." It's become a fetish appellation (right down there with "interoperability"), an excuse for not getting anything actually done anytime soon.

Adrian Gropper, MD (4/8/2013 at 9:38 AM)
ONC needs to do more than just hand out grants that pave the cow path of our current system. They need to link the Stage 2 mandate for Direct messaging to state health information exchange use of Blue Button+ for exactly the reasons Yasnoff mentions at the end of this article. Please see:

Work continues on stage 3 meaningful use rules
Federal officials have made it clear that the industry won't see any official policy proposals for stage 3 meaningful use this year, but the Health IT Policy Committee continues to whittle away at what the eventual proposal may look like.

In the April meeting, members of the committee's Meaningful Use Workgroup presented a report on their latest ideas. Most notably, workgroup member Christine Bechtel, vice president of the National Partnership for Women and Families, signaled a desire to consolidate into a smaller number of measures many of the meaningful use measures that had been discussed previously.

For example, she talked about how the workgroup had considered measures that would have required physicians to separately record patient preferences for receiving educational materials, appointment reminders and clinical summaries. However, she said it would be much easier to include a provision in the updated EHR certification criteria that would allow doctors to record patient preferences once, then use this for all services. One new certification criteria could eliminate three meaningful use objectives.

Workgroup chair Paul Tang, M.D., vice president and chief innovation and technology officer at Palo Alto Medical Foundation, suggested stage 3 could include an "alternative pathway" to meeting the meaningful use objectives. Since stage 3 will likely focus more on meaningful use of data and less on specific technology adoption, it will be less important to make sure providers follow a protocol for EHR implementation and data capture. Instead, it may be possible for regulators to look at specific outcomes for disease treatment and prevention, as well as performance in the earlier meaningful use stages, and assume the provider is using an EHR system as intended.

The full policy committee will consider these reports and decide whether to pass any further recommendations along to the ONC.

It'll be interesting to see whether there will in fact be a Stage 3. may be possible for regulators to look at specific outcomes for disease treatment and prevention, as well as performance in the earlier meaningful use stages, and assume the provider is using an EHR system as intended.
Would you like some syrup with that waffle? The vendors will shoot that one down. They want to charge you for Stage 3 upgrades.

More to come...

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