IT headaches await next CMS administrator

The legacy of outgoing CMS Administrator Marilyn Tavenner will be inextricably intertwined with the complex pursuits of nudging the healthcare industry toward more and better use of information technology, and switching to ICD-10 procedural and diagnostic codes.

Her agency, along with the Office of the National Coordinator for Health Information Technology at HHS, oversaw the rollout of the electronic health record incentive-payment program, in which 94% of eligible hospitals and 79% of physicians and other eligible professionals shared in $26.4 billion in payments through November of last year, the latest CMS data show.

But the program also has its troubles. It's facing resistance from some providers over its pace and their problems meeting its more difficult Stage 2 meaningful-use requirements.

“She led during one of the most difficult times, whether that (was) website issues or getting things going with the (federal health insurance) exchange, or Ebola, or trying to transform an industry through health information technology,” said Russell Branzell, CEO of the College of Healthcare Information Management Executives, an association of hospital chief information officers. “Anybody can lead in easy times. She took her shots.”

That praise notwithstanding, Branzell said the meaningful-use program needs more flexibility. Much work also remains to be done with interoperability standards, including a standardized way to more effectively match patients with their medical records, he said.

“The person who comes behind (Tavenner) is still left with a plate that's very full, and needs to understand they still have significant work to do,” Branzell said.

The person coming behind Tavenner as acting administrator will be Andy Slavitt, who joined the CMS last year to help fix HealthCare.gov.

Slavitt has an extensive background in health IT from the consumer and health plan perspective. He founded Health Allies in 1999, a company that helped consumers consolidate and better understand multiple bills from their healthcare providers. The service also provided consumers with healthcare pricing information, provider experience levels and locations.

Health Allies was acquired by UnitedHealth Group in 2003. He stayed on in various roles at United, including as CEO of its health IT and data analytics arm, then called Ingenix, now Optum Insight, and later as group executive vice president of Optum, the insurer's “health services platform,” of which OptumInsight is a unit. Optum is heavily involved in datamining for research.

As such, it has been targeted for criticism by a noted privacy advocate.

Slavitt came to the CMS last year.

Federal policy advisers who weighed in on Stage 3, (its rules are in the final stages of the rulemaking process) called for the CMS to scrap many previously proposed criteria to focus on solving the interoperability problem that has humbugged the health IT industry for decades.

Tavenner also was embarrassed last year by Congress when, soon after delivering a speech at a health IT trade show affirming that that CMS would not postpone its then-scheduled compliance deadline for rolling out the ICD-10 codes, the legislators intervened, ordering at least a one-year delay for ICD-10.

CMS subsequently reset the ICD-10 start date for Oct. 1, 2015, but even that is being challenged. It faces strong opposition from the Texas Medical Association and the American Medical Association.

Many challenges with the meaningful-use program and ICD-10 conversion await the next CMS administrators.

“I'm significantly saddened to see her go,” said Dr. William Bria, head of the Association of Medical Directors of Information Systems, a professional association for physician informaticists. “It's probably been one of the most challenging times in that role in a generation or maybe two. Balancing all of the challenges to make America's largest healthcare [system] work was on her shoulders. She brought intelligence and compassion to that role.”

The next five years for Tavenner's replacement (and the one to follow, assuming the next president chooses someone new) are going to be “a bumpy ride,” Bria predicted.

“Meaningful use needs to transition to meaningful care,” Bria said. “The emphasis on the technology was never the goal. Never. We have to demonstrate actual improvement in the care we're delivering and make it ubiquitous. That's going to be the hardest thing.”

Dr. Farzad Mostashari, whose tenure as HHS' National Coordinator for Health IT coincided with much of Tavenner's at the CMS, said he was "not surprised at all to see her taking a breather after a very intense period” in CMS history.

The agency saw its role change very quickly over the past several years, Mostashari said, from one primarily tasked with paying claims to a leader in the movement to meet the so-called triple aim of improving patient experiences and outcomes improving population health and lowering healthcare costs.

Meanwhile, the CMS' IT infrastructure was woefully behind the times, said Mostashari, who left the ONC in 2013 and is now CEO of health IT startup Aledade. “I remember vividly sitting across from Marilyn discussing something that was good policy and we went around the room and everyone agreed it was good policy and the chief of operations would say, 'Nope, we can't do it because we can't change the IT system,'” he said.

"The same sort of creativity people have on the policy side has to be brought to bear on the IT infrastructure side to support the policy," Mostashari said. "That's a big challenge.”

Follow Joseph Conn on Twitter: @MHJConn