HHS should suspend incentive payments to providers in the electronic health-records program and delay penalties to those that do not integrate health IT until the federal department can define clear, interoperable standards, House Republican leaders suggested Thursday in a letter to HHS Secretary Kathleen Sebelius
During a seven-week congressional recess, the chairmen of the House Energy and Commerce and Ways and Means Committees and respective health subcommittees charged that nearly $10 billion in federal dollars may have been wasted because the recent Stage 2 Meaningful Use program rules from the CMS and the Office of the National Coordinator for Health Information Technology are “weaker” than the Stage 1 rules released three years ago.
“The Stage 2 rules fail to achieve comprehensive interoperability in a timely manner, leaving our healthcare system trapped in information silos, much like it was before the incentive payments,” Reps. Dave Camp (R-Mich.), Fred Upton (R-Mich.), Wally Herger (R-Calif.) and Joe Pitts (R-Pa.) wrote in their letter to Sebelius on Oct. 4.
The conservative lawmakers also called on HHS to expect more from meaningful users. “For example, requiring a summary transfer when a patient moves to a different care setting in electronic format only 10% of the time is insufficient,” they wrote, adding that also only requiring radiology and laboratory orders to be electronic 30% of the time and medication reconciliation and electronic prescribing to happen 50% of the time is “woefully inadequate.”
So far, the EHR incentive payment programs created by Congress under the American Recovery and Reinvestment Act of 2009 have, through June of this year, disbursed $7.1 billion through not quite two full years of operation, according to the latest CMS data (PDF)
. Nearly 294,300 physicians and other “eligible professionals” have enrolled for EHR incentive payments under the Medicare, Medicare Advantage and Medicaid programs and not quite 140,500 have been paid, according to the CMS.
There are 3,973 hospitals enrolled in the Medicare and Medicaid incentive programs and they have received 3,905 payments under one or the other or both, according to the CMS.
The ARRA also directly appropriated $2 billion to the Office of the National Coordinator for Health Information Technology for IT programs, including promotion of state-wide health information exchanges.
ONC chief Dr. Farzad Mostashari, speaking to a conference of chief medical information officers in Chicago, when asked during a question-and-answer session about the letter, said that his office was initially created by executive order of Republican President George W. Bush and has ever since “has enjoyed bipartisan support.” But “a few weeks before an election is still the silly season,” Mostashari said. “That's what they call it in Washington.”
Seventy percent of hospitals have registered for the EHR incentive payments, and 55% have received their first-year payments, Mostashari said. Healthcare organizations have made plans and are looking for that money to be paid. “This is a commitment that we cannot lightly pull back,” Mostashari said. “It's not just, 'you promised,' it's the importance of it.” But, he said, rescinding the program would require legislation that would have to pass both houses of Congress, be reconciled, and “the president would have to sign it.”
“Sometimes it's useful to remember how American government works,” he said.
Earlier, in his formal presentation, Mostashari noted there has been criticism about lack on interoperability, but he defended the government's effort, first focusing not only on adoption, but also on development of IT standards that made interoperability technically possible, and changes in payment mechanisms in the healthcare reform law, such as value-based purchasing, that provide a business case for interoperability. The so-called Stage 2 meaningful-use criteria
by the CMS in a final rule in August, and effective in 2014, are “all about interoperability,” he said.