CHICAGO—Health IT leaders are happy that Congress has approved the long-awaited “doc fix." Now they're hungry for the government to flesh out key details about how it will change their work.
The bill replaces the payment formula that perennially threatened deep cuts to physician payments with two payment schemes. One gives doctors larger annual rate increases if they have a significant portion of their revenue under value-based models. The other adjusts physicians' pay according to a “merit-based incentive payment system" with bonuses and penalties that depend in part on the use of health information technology.
The legislation reorganizes several of Medicare's existing incentive programs and adds new incentives for the adoption of data analytics, telehealth and the speedy sharing of health information. Physicians will still have to meet the government's requirements for the meaningful use of EHRs, but that will now be one component of the new scoring system.
Dr. Karen DeSalvo, the head of HHS' Office of the National Coordinator for Health IT, said the role of the meaningful-use rules may evolve as they're rolled into the new framework. “We've been thinking about it at HHS and ONC," DeSalvo said Tuesday at the convention of the Healthcare Information and Management Systems Society in Chicago. "We know there is an opportunity to move into a new definition of meaningful use. We've been talking about it to be ready.”
The legislation has the potential to reshape how clinicians interact with their health IT, said Eric Helsher, vice president of client success at Epic Systems Corp. "It's another example of the industry's journey towards, potentially, 100% pay-for-performance models,” he said.
The consolidation of data reports for quality measures should simplify physicians' experiences with their EHRs, Helsher said. Vendors, he said, may have to develop fewer algorithms to summarize and calculate the data measures, but that depends on how those metrics are determined.
It remains to be seen how physicians will react to a scoring system that puts less priority on meaningfully using EHRs. Dr. Michael Zaroukian, chief medical information officer at Sparrow Health System, Lansing, Mich., said it's good "if the goal was to help if you didn't have to have a perfect score to avoid a penalty." But Zaroukian said he needed more details to decide whether the approach risks overly diluting the meaningful-use requirements.
The bill also states that it's a “national priority” to achieve widespread interoperability by 2018. To achieve that, HHS will have to define metrics to judge the pervasiveness of interoperability by 2016. At the end of 2018, the agency must determine whether pervasive data-sharing has occurred and, if not, submit a report to Congress explaining why.
The legislation also includes a section asking providers and hospitals to attest they have not willfully blocked information with practices such as disabling functionality in their EHRs. That section drew praise from McKesson and the trade group Health IT Now.
But the bill does not specifically define what information-blocking is. The administration attempted to define the concept in its April 10 report to Congress. It states that information-blocking occurs when providers “knowingly and unreasonably interfere” with electronic sharing of information. The report suggests that privacy and patient safety, among other goals, may be advanced by blocking information from flowing freely.
However, the report also lists “legitimate economic goals” as a reason for blocking information, and that may be difficult for the executive branch to define in the new, post-SGR environment.
Jeff Smith, senior policy adviser for the College of Healthcare Information Management Executives, said it's unclear whether the legislation's attention to the issue "will improve the state of play, above and beyond the current strategy being pursued by ONC." But, he added, the language ensures the government will continue to pay attention to it.
