The bill introduced Thursday to replace Medicare's sustainable growth-rate formula for physician pay would also significantly alter federal policy on health information technology.
Lawmakers avoided making any changes to the timeline for requiring the industry to switch to ICD-10 diagnostic and procedure codes. Last year's temporary "doc fix" included a stealthily added delay of the conversion.
But the legislation's merit-based incentive payment system would fundamentally change the government's program promoting the adoption and "meaningful use" of health IT. Under the current program, failure to meet meaningful-use requirements will trigger penalties beginning this year. Under the SGR bill, meeting the standards would yield a bonus.
That's not all. The bill would also reward remote patient-monitoring and telehealth as clinical practice improvement activities. “Those are all good things,” said Joel White, the head of Health IT Now, which describes itself as a coalition of patient groups, provider organizations, employers and payers.
Lawmakers have also used the legislation to take aim at obstacles to realizing the benefits of IT in healthcare, particularly the lack of interoperability, or data-sharing, between electronic health records.
The SGR bill establishes a July 2016 deadline for HHS to develop metrics to quantify progress toward more data-sharing among hospitals and other providers. HHS would have to account for the progress by December 2018.
“The industry as a whole would benefit from a conversation” that starts because of those metrics, said Jeff Smith, the vice president of public policy for the College of Healthcare Information Management Executives.
Stephanie Zaremba, senior manager of government and regulatory affairs with Athenahealth, agreed that the industry would benefit from federal metrics on data-sharing. “We need some actual numbers,” she said. “We've spent $30 billion on software that in theory exchanges information. Now we need to actually do it.”
But generating such metrics could be a complicated endeavor. They could examine the technical capability of the software to exchange information—that is, whether the data could flow and whether it occurred without introducing errors into the record. Or they could assess whether data is actually being exchanged or not.
“It is a difficult task to try and develop a scoring system that would allow you to figure out performance,” Smith said, though it appears to be aligned with the goals of HHS' Office of the National Coordinator for Health Information Technology.
The SGR bill also asks for a flurry of reports. HHS, for example, would be tasked with studying ways to help providers compare various EHR systems, such as a website aggregating surveys from physicians and hospitals that use the products.
The comptroller general would be asked to assess how private insurers are promoting the use of remote patient-monitoring and the barriers to wider adoption of the technology for Medicare beneficiaries.
The bill also requests a study on the feasibility of allowing small groups of physicians to work with independent risk managers to help them participate in risk-based payment models.
That provision has piqued Athenahealth's interest, Zaremba said. “What we want to do,” she said, “is go to CMS and private payers and negotiate nationwide for providers to plug into.”
Last year's version of the SGR overhaul contemplated requiring the use of clinical decision-support software—which analyzes data and gives doctors guidance—to promote appropriate use of imaging. That provision has been dropped from the SGR legislation but was added to a different bill that became law.
Follow Darius Tahir on Twitter: @dariustahir