Editor's note: Following is an excerpt of the transcript of an editorial webcast, “On your marks; get set for federal EHR program,” conducted by Modern Healthcare on Sept. 29. The four panelists discussed and debated the government's meaningful-use criteria that will be used to determine who will get federal financial subsidies for their information technology programs. The panelists were Chip Kahn, president and CEO of the Federation of American Hospitals; Don May, vice president of policy for the American Hospital Association; Farzad Mostashari, deputy national coordinator for programs and policy in HHS' Office of the National Coordinator for Health Information Technology; and Robert Tennant, senior policy adviser for the Medical Group Management Association. Modern Healthcare reporter Joseph Conn moderated the webcast.
The next stage for IT
What to expect as EHR subsidies roll out, and in the wake of midterm elections
Joseph Conn: I listened to a recent meaningful-use work group meeting of the HIT Policy Committee, and there was a lot of discussion about the timing of going into Stage 2. As you know, they were beginning work on the Stage 2 meaningful-use criteria—and some discussion touched on how they're going to get feedback from people trying to implement Stage 1. All three of the speakers in different words basically raised the same issue about maybe moving too fast before we know if any of this stuff in Stage 1 works. How is the administration going to be handling that feedback loop and making adjustments into Stage 2 or even making a serious evaluation of Stage 1—that maybe the timing thing is just too tight?
Farzad Mostashari: There's a little bit of a rock and a hard place on this issue. Obviously, the vendors want as much lead time as possible. They've asked for a minimum of 18 months before there are any new criteria. And if you take into consideration the time it takes to do regulatory process, we'd have to start rulemaking now for Stage 2 if we wanted to enable as much time as possible for Stage 2. On the other hand, there is a real desire for empiricism, kind of evidence-based policy, where we see what the experience is with Stage 1. I think we have to be creative on both ends, and I think we'll work hard to garner experience as soon as we can.
That means things like the meaningful-use vanguard, the movers as we call them affectionately, those are the providers who are most ready, working with the extension centers—and systematically gather their experiences and understand what are the criteria that are difficult for them to meet. And what are those that are more difficult for even the more-advanced providers to meet in those initial stages. It will also mean that we're going to need quicker feedback loops. We can't have a year between when the attestation is made and when there is the final information back in terms of whatever the results of that is. We're working very hard with colleagues, and Tony Trenkle at the CMS (director of the agency's office of e-health standards and services) is committed to having a shorter feedback loop on this Stage 1 experience.
We also have to consider ways in which—and I would love everyone's input on this and certainly will be part of an opportunity in the proposed rule—to suggest other ways on the other ends that we could provide as much flexibility as possible. We provided, for example, in Stage 1, the ability to do 90-day reporting for the first year of meaningful use, so that's something that people can comment on, whether that should be continued or not. There are other ways of achieving that same goal, but I think those are two imperatives. They're both important imperatives. We want to learn from Stage 1; we also want to give people as much time as possible to prepare for Stage 2, and we just have to work at both ends of that.
Joseph Conn: If the GOP takes the House in November, will budget-deficit hawks try to reduce or even eliminate the IT subsidies under the American Recovery and Reinvestment Act?
Chip Kahn: First, we won't know what the future is till we get there. And what may occur ... will be a watershed election, and if it is a watershed election, then I think that we probably will experience in 2011 some stalemate. My guess would be—and this is “buyer beware” here—that at least into the near future of all the things that might be affected in health reform, this is one that probably wouldn't be changed. Even if there is legislative action, there won't be a bill signed by the president that would enact changes. But I think over time, the jury's out as to what will be the effect of the election on the health reform agenda.
Robert Tennant: I agree 100% with that. I think the only thing that I would add would be that health IT and improvements in the administrative simplification areas are one of the few areas in Washington where we've seen any bipartisan agreement. So I think we pretty much all agree that we need to improve the healthcare set—by making it more efficient and improving patient care. So I think that may be one of those areas that may be off the table.
Don May: I agree with both of them, and I think there's one other nuance with this program that's important to note is: This has become a Medicare payment. And Medicare payments are entitlement programs. They happen automatically. … I believe most of the discussion around kind of pulling back, if Republicans were to win, is really focused around the appropriations side.
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