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Monday, November 10, 2014

Meaningful Use and total GOP control of Congress. What's next?

What will happen to the Meaningful Use program now? Is it simply, in relative terms, too piss-ant to even bother with, given other much larger, more pressing, politically radioactive items such as immigration, Keystone XL, "Free Trade," the reinvogorated ObamaCare takedown challenge, ISIL, Iran, climate change (and the hated EPA)?

2014 MU Attestations and incentive payments through Q3 are pretty puny. 2014 may shake out with perhaps 15-20% of the action of 2013 and 2012 respectively, even assuming a Q4 uptick.

Click the image to enlarge.

Better than 90% of MU money has been distributed. ONC is out of leadership (all the brave talk notwithstanding), out of dough, and still slavishly devoted to their espoused "non-regulatory, market-based incentives approach" to Interoperababble.
Republican Congress could spur meaningful use slowdown
CIOs think needed changes to meaningful use may happen with a Republican Congress, but health IT advocates fear trouble with ONC in disarray.

The midterm election near sweep that gave Republicans control of both houses of Congress could help move a CIO-inspired meaningful use reform bill, as it elevates a leader of the Senate GOP "Reboot" group critical of meaningful use.

Meaningful use was already under the gun before the elections, and the election results will likely intensify that trend, according to health IT legislative specialists.

The Democratic administration's program was facing a growing backlash among CIOs and leaders in most sectors of health IT, who had coalesced in fall 2014 to demand that CMS and ONC back off from what many doctors and hospital executives saw as too demanding a pace...

Meanwhile, turnover and instability at ONC, as well as diminishing funding in the past two years of the Obama administration, have further weakened the agency, according to health IT advocates.

"The cost of the interregnum at ONC is that they have been unable to decide where to focus their energies and that's unfortunate," said David Harlow, a Boston lawyer and health IT blogger who served on ONC's Health IT Standards Committee...
Why Is Healthcare IT Under Fire?
The Office of the National Coordinator for Health IT has lost several key figures in recent months. An economic report suggests that meaningful use may have been a waste of money. Why is healthcare IT under such duress?

It's been a rough year for the Office of the National Coordinator for Health IT – and it's unclear when things will get better...
Washington Debrief: How the Republican Election Victories Impact Health IT Reform
As 2014 MU Attestations Lag, Healthcare IT Leaders Worry about 2015

Key Takeaway: Centers for Medicare and Medicaid Services (CMS) data released during the November Health IT Policy Committee indicate that 2014 attestations are lagging, compared with 2013. Approximately 1,900 hospitals have attested to either Stage 1 or Stage 2 of Meaningful Use (MU) in 2014, compared with nearly 3,400 in 2013.

Why it Matters: Participation rates released last week validate industry concerns that changes to MU, meant to provide flexibility in 2014, will be greatly muted by providers’ inability to meet more difficult program requirements for a full year in 2015.

CMS figures indicate that approximately 2,560 hospitals were scheduled to meet Stage 2 Meaningful Use in 2014. However, new flexibility from a final rule released on September 4 gave hospitals the ability to repeat Stage 1 if they could not meet Stage 2 requirements, and they could attest to having troubles with 2014 Edition CEHRT implementation. Despite lowered expectations of Stage 2 hospital participation, CMS data released last week show that 840 hospitals have met the Stage 2 bar, over a 90-day reporting period, in 2014; this amounts to less than one-third of hospitals scheduled to meet Stage 2 in 2014, and health IT leaders worry this data paints an ominous picture of the program’s near-term future.

In 2015, nearly 4,000 hospitals are scheduled to meet Stage 2 Meaningful Use requirements for a 365-day reporting period. CHIME and other health IT leaders say this will put senseless stress on program participants and will impede program success, because many hospitals will be unable to achieve the next phase of MU...
Just search "Meaningful Use" at Google News. Plenty of speculative chatter.

Here's a doozy via Politico, one having nothing to do with the midterms:
EHR RECORD CERTIFICATION PROCESS DRAWS CONCERN: An alarmingly high percentage of electronic health records were certified by ONC without ever being tested on physicians or other clinical staff, which may partly explain why doctors and nurses find the software so clunky, hard to use and occasionally dangerous, according to a research team from MedStar’s National Center for Human Factors in Healthcare. They examined the products of 62 ONC-certified EHR vendors and found that 25 percent had not been tested on physicians; 10 percent were not tested on clinical staff of any kind. Sometimes as few as two people were involved in the end user testing of the products — and sometimes those two were employees of the EHR vendor. The unpublished study was discussed at a federal IT policy committee meeting Friday that centered on whether ONC’s EHR certification process should be made more rigorous.
Well, it goes to the fact that certification has solely to do with whether you can enter and retrieve the requisite MU data, no matter how clunky the process. We at Clinic Monkey have known that all along.



So, HHS allowed the $673 million Regional Extension Center initiative expire after just four years (only 3 of which -- max -- were truly operational). Now, they're gonna spend $840 million on this:
Transforming Clinical Practices Initiative

The Transforming Clinical Practice Initiative is designed to help clinicians achieve large-scale health transformation. The initiative is designed to support 150,000 clinician practices over the next four years in sharing, adapting and further developing their comprehensive quality improvement strategies. The initiative is one part of a strategy advanced by the Affordable Care Act to strengthen the quality of patient care and spend health care dollars more wisely...
That's an average of $1,400/year per provider, $117/month.

Meanwhile, we'll take money away from the docs over "here."

The AMA’s Usability Initiative Is a Good Start, so What Comes Next?
Jerome Carter's EHR Science blog is a must-read for anyone who cares about improving Health IT.


Click to enlarge.



As I pointed out in my prior post, it's really a simple matter in terms of the plain English of PPACA Section 1321.

From SCOTUSblog:
Symposium: The grant in King – Obamacare subsidies as textualism’s big test
Abbe R. Gluck is a Professor of Law at Yale Law School.

Obamacare’s opponents have depicted the challenges in King v. Burwell, Halbig v. Burwell, and the other subsidies cases as the choice between clear statutory text and vague notions of statutory purpose.   This is a smart strategy, because it creates the illusion of an easy choice for the Court’s textualists, and even for most of the other Justices...

Justice Scalia’s own statutory interpretation treatise argues (at pages 63 and 168) that “there can be no justification for needlessly rendering provisions in conflict if they can be interpreted harmoniously,” and that statutory provisions should not be interpreted to render them ineffective or superfluous.

Textualists also advocate structural, contextual interpretation. As Justice Scalia’s treatise puts it (at 168): “[N]o interpretive fault is more common than the failure to follow the whole-text canon, which calls on the judicial interpreter to consider the entire text, in view of its structure and of the physical and logical relation of its many parts.” The subtitles of the ACA immediately surrounding the provision in question are a set of interlinking pieces: they add new requirements on insurers to make insurance accessible; impose the infamous individual mandate on the public to populate the insurance pools; and create the federal and state exchanges and authorize the subsidies (which the exchanges deliver) to make insurance purchase accessible and affordable enough for the individuals now required to purchase it. In their 2012 joint dissent in NFIB v. Sebelius, Justices Scalia, Kennedy, Thomas, and Alito read these parts as making no logical sense without one another and also read the statute to include subsidies on federal exchanges:

“Congress provided a backup scheme; if a State declines to participate in the operation of an exchange, the Federal Government will step in and operate an exchange in that State.”
and then:
“That system of incentives collapses if the federal subsidies are invalidated. Without the federal subsidies, individuals would lose the main incentive to purchase insurance inside the exchanges, and some insurers may be unwilling to offer insurance inside of exchanges. With fewer buyers and even fewer sellers, the exchanges would not operate as Congress intended and may not operate at all.”...
Should SCOTUS strike down the federal HIX clause, it will truly be nothing more than egregiously partisan "legislating from the bench."

More to come...

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