Government & Policy

Project ECHO, a health IT pilot that launched in 2003 in rural New Mexico to connect rural doctors to specialists, is now front and center in Congress as lawmakers consider employing the model across the country. Senators Orrin Hatch, R-Utah, and Brian Schatz, D-Hawaii, introduced the Expanding Capacity for Health Outcomes Act this past week. The bill calls for studies on how best to expand the model. In New Mexico, Project ECHO has recorded unprecedented success in treating patients with hepatitis C. "Project ECHO has proven that technology can help overcome traditional barriers to adequate healthcare treatment, such as distance, income and lack of specialized medical professionals for underserved communities with no access to treatment," Sanjeev Arora, MD, project director, told Healthcare IT News back in 2008. [Also: IT employed in hepatitis-C fight in rural New Mexico] The initiative is underpinned by a Web-based application developed by Infosys Technologies. Project ECHO – it stands for Extension for Community Healthcare Outcomes – was funded by Agency for Healthcare Research and Quality, so the federal government already has a hand in the effort. "In states with large rural populations like Utah, it's vital that we do everything we can to ensure that patients have access to quality health care – no matter where they live," Hatch said in an April 29 statement posted on his website. "Our bill would help connect primary care providers in underserved areas with specialists at academic hubs, making it easier for medical professionals to access the continuing education they need and provide health care to more people," added Schatz. The bill requires the Department of Health and Human Services to work with the Health Resources & Services Administration to prioritize analysis of the model, its impacts on provider capacity and workforce issues, and evidence of its effects on quality of patient care. It calls on GAO to report on how increased adoption of a Project ECHO model might boost efficiencies and potential cost savings and improve healthcare. It also requires HHS Secretary Sylvia Burwell to submit a report to Congress on the findings of the GAO report and the HHS report, including ways such models have been funded by HHS and how to integrate the models into existing funding streams and grant proposals.

Andrew Bindman, MD, will take the helm at the U.S. Agency for Healthcare Research and Quality. Under the umbrella of the Department of Health and Human Services, AHRQ is charged with finding ways to improve healthcare by making it more accessible, affordable, equitable – and safer.

A group of Republican senators who have been looking to "reboot" meaningful us since 2013 released new draft legislation this week they say aims to make the incentive program work better for providers and taxpayers. U.S. Senators John Thune, R-South Dakota, Lamar Alexander, R-Tennessee, Mike Enzi, R-Wyoming, Pat Roberts, R-Kansas, Richard Burr, R-North Carolina and Bill Cassidy, R-Louisiana – all of whom voted against the 2009 ARRA law that helped establish meaningful use through the HITECH Act – wrote this week to HHS Secretary Sylvia Burwell and CMS Acting Administrator Andy Slavitt, looking for feedback on the bill. [Also: Republican senators want to ‘reboot’ MU] The draft legislation would shorten the reporting period for eligible physicians and hospitals from 365 days to 90 days, which would give providers more time to implement EHR systems, relax the all-or-nothing nature of the current program requirement, and extend the ability for eligible providers and hospitals to apply for a hardship exemption from the meaningful use requirements. "These policies seek to provide CMS with the tools and guidance necessary to advance the use of EHRs as part of utilizing health IT to the benefit of patients in a manner that protects the significant taxpayer investment in our nation’s health care system," the legislators write. Thune, Alexander, Enzi, Roberts, and Burr are original members of the Senate’s health IT working group, known as Re-examining the Strategies Needed to Successfully Adopt Health IT, or REBOOT. Back in 2013, they published a white paper outlining their complaints about lack of momentum toward interoperability, patient privacy concerns, EHRs' potential to enable fraud and abuse and other concerns about federal health IT policy. [Also: EHRA critiques GOP's MU 'reboot' plan] "We received critical feedback in response to our 2013 report which has informed our work on these issues," the senators wrote to Burwell and Slavitt this week. "We also engaged with stakeholders including health IT developers, providers, and patient-focused organizations to assess their experiences with the meaningful use program, as well as their concerns with the state of health IT, specifically EHRs, over the years. "In response to this feedback we have identified a few key policy changes outlined in the enclosed draft legislation, and we respectfully request feedback as part of our continued constructive dialogue on these issues."

On Twitter, former National Coordinator for Health IT Farzad Mostashari, MD, called it the "most substantive change to how healthcare is paid for in a couple of decades." The propsed MACRA rule put forth by the U.S. Department of Health and Human Services on Wednesday also holds some pretty big changes for how health IT can be put to work by physicians to drive quality improvement and cost efficiencies. [Also: MACRA proposed rule published by HHS, streamlining federal programs including meaningful use] "By proposing a flexible, rather than a one-size-fits-all program, we are attempting to reflect how doctors and other clinicians deliver care and give them the opportunity to participate in a way that is best for them, their practice and their patients," said Patrick Conway, MD, chief medical officer at the Centers for Medicare & Medicaid Services, in announcing the rule. "Reducing burden and improving how we measure performance supports clinicians in doing what they do best – caring for their patients." So far, most industry reaction to the notice for proposed rulemaking is positive – recognizing the fact CMS seems to have taken the feedback from more than 6,000 frontline healthcare stakeholders to heart, crafting a rule that's attuned to the needs of physicians. In a statement, HIMSS applauded the "significantly streamlined reporting and the acknowledgement process for MIPS-eligible clinicians" in the new rule. "We are encouraged by CMS's effort to coordinate reporting periods across federal programs and the decision to align with the ONC Interoperability and Certification Programs," HIMSS officials said. "With the first MIPS performance full-year reporting period expected to begin on January 1, 2017, we're further analyzing the MACRA rule to ensure that Medicare providers will be able to meet the proposed requirements." American Medical Association President Steven Stack, MD, meanwhile, said it's "hard to overstate the significance of these proposed regulations for patients and physicians." In particular, he was pleased that CMS has been listening to physicians’ concerns and "has made significant improvements, by recasting the EHR meaningful use program and by reducing quality reporting burdens." American Health Information Management Association CEO Lynne Thomas Gordon released a statement saying AHIMA supports the MIPS progam's "emphasis on interoperability, information exchange and security measures, which we believe are critical to reaching the rule’s stated long-term goal of ‘better care, smarter spending, and healthier people.'" The Premier healthcare alliance was less pleased, however – specifically taking issue with one part of the two-pronged MACRA approach to value-based care: its provisions related to advanced payment models, or APMs. CMS "made a significant mistake in not including any bundled payment or Track 1 Medicare Shared Savings Program ACOs as qualifying advanced payment models under MACRA," said Blair Childs, senior vice president of public affairs at Premier Inc. "Rather than rejecting bundled payment programs, we believe CMS should focus on ways to alter the bundled payment programs to demonstrate use of certified EHR technology and align measures with other Advanced APMs. "We also believe CMS seriously erred in excluding Track 1 MSSP ACOs in the APMs for failing to meet the more than 'nominal risk' financial requirement," said Childs. "As we've learned through members in our Population Health Management Collaborative, these programs require providers to not only forego revenue through a lower volume of services, but also investment millions of dollars in redesigning care through new technologies, data analytics, additional staff, etc.," he said. "We think most businessmen would call that more than nominal risk, yet CMS choses to define it as only cases where there is risk to the government." Elsewhere in the Twitterverse, the response was mostly positive – with some skepticism and a bit of I-told-you-so mixed in. And "Meaningful Use" is going "away" by changing its name to "Advancing Care Information" #MACRA #livetweeting as I read the proposed rule — Joy Rios (@askjoyrios) April 28, 2016 or basically what #MU should have been from day 1 @Travis_Broome — Harold Smith III (@haroldsmith3rd) April 28, 2016 1/Bottom Line #MACRA NPRM Game changer. Lots of great changes, 100's of thoughtful details and decisions. Biggest blind spot can be fixed — Farzad Mostashari (@Farzad_MD) April 27, 2016 Really good YouTube "whiteboard" connecting the dots of our MACRA announcement. Plain English. No acronyms. Wow. https://t.co/qLHSpYnWRX — Andy Slavitt (@ASlavitt) April 27, 2016 A tree died for this #MACRA #MIPS #Medicare pic.twitter.com/YsiSd3R9Mf — Amanda Narod (@AmandaBinDC) April 28, 2016

A bill to establish the Office of the Chief Information Security Officer within the U.S Department of Health and Human Services was introduced in the House of Representatives this week. On April 26, Energy and Commerce Committee Members Rep. Doris Matsui, D-California, and Rep. Billy Long, R-Missouri, introduced the HHS Data Protection Act to elevate the HHS CISO from its current position under the HHS' chief information officer. "The integration of information technology into nearly every aspect of our daily lives means our security landscape has changed dramatically," said Matsui said in a statement. "As the network of cybercriminals becomes increasingly sophisticated, our operational structures and strategies must evolve accordingly." The bill  builds on the Obama Administration's Cybersecurity National Action Plan, which emphasizes the need for a CSIO to improve cybersecurity. In response to the plan, the Administration created a Federal Chief Information Security Officer position to exclusively focus on Federal cybersecurity operations. The legislation is in part a response to the committee's August 2015 report on the FDA's information security that found "pervasive and persistent deficiencies across HHS and its operating divisions' information security programs" after its internal network was breached. "It's impossible to completely eradicate the threat of cyber-attacks, but the American people deserve to know their sensitive information is being safeguarded with the utmost security," said Long, in a statement. "In light of recent data breaches across America's federal agencies, we have the responsibility to root out vulnerabilities and maximize data protection to give them that peace of mind," he said.

The U.S. Department of Health and Human Services issued a long-awaited proposed rule for the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, on Wednesday, ushering in some big changes for the ways physicians are assessed for quality of care and use of information technology.    

A legal expert discusses the Office for Civil Rights' outreach to the healthcare and technology industries on the subject of where and how HIPAA does and does not apply in the growing arena of mHealth.

In the first major overhaul of Medicaid managed care requirements in more than a decade, the Centers for Medicare and Medicaid Services published new rules on April 25 that affect how Medicaid works for the nearly two-thirds of beneficiaries who get their coverage through private managed care plans. It aligns key rules and practices with those of marketplace and Medicare Advantage, including the addition of reporting medical loss ratio to Medicaid to ensure managed care plans focus on delivering care, not profits, CMS said. The rule finalizes a medical loss ratio at 85 percent. Insurers must spend at least 85 percent of their Medicaid revenue on medical care to improve quality. The remaining 15 percent may be spent for administrative reasons such as salaries and marketing, CMS said. Health plans that don't meet the goal will face future penalties in having their state rates lowered. On the health information technology front, the rules encourage – but don't require – commitment to the principles of health information exchange "Health information technology and the electronic exchange of health information are important tools for achieving the care coordination objectives proposed," according to the final rule. HHS "supports the principle that all individuals, their families, their healthcare and social service providers, and payers should have consistent and timely access to health information in a standardized format that can be securely exchanged among the patient, providers, and others involved in the individual’s care," it states.   "Further, the Department is committed to accelerating health information exchange through the use of health IT across the broader care continuum and across payers. Health IT that facilitates the secure, efficient and effective sharing and use of health-related information when and where it is needed is an important contributor to improving health outcomes, improving health care quality and lowering health care costs." Specifically, the rule points to ONC's Nationwide Interoperability Roadmap and 2016 Interoperability Standards Advisory as containing the "best available standards and implementation specifications to enable priority HIE functions." Providers, payers, and vendors are encouraged to take them into account "as they implement interoperable HIE across the continuum of care, including care settings such as behavioral health, long-term and post-acute care, and community service providers." CMS also sets the conditions for broader applications of telehealth, specifically as a way to bolster network adequacy standards. "Several commenters recommended that CMS add elements (to the rule) to include triage lines or screening systems, as well as the use of telemedicine, e-visits, and/or other evolving and innovative technological solutions," officials write. "We agree with commenters that such services and technological solutions could impact the needs of enrollees in a particular area and could change the manner and extent to which other network providers are needed and utilized. We encourage states to consider how current and future technological solutions could impact their network adequacy standards." An estimated 72 million Americans currently rely on Medicaid as their source of health insurance coverage, 14 million more than in 2013, CMS said. This is largely due to the Affordable Care Act's coverage expansion. The improvements modernize the way managed care health plans operate so that Medicaid and CHIP continue to provide cost-effective, high quality care to consumers, according to Monday's announcement by Andy Slavitt, CMS acting administrator and Vikki Wachino, CMS deputy administrator and director for the Center for Medicaid and CHIP Services. The rule strengthens states' efforts to support delivery system reform and authorizes the first-ever Medicaid and CHIP quality rating system so that states can publicly report plan quality information, and people can use that information to select plans, CMS said. The rule also addresses quality of care standards, as well as focusing on improved communications, such as electronic notices to beneficiaries and creating online provider directories. "States are making gains in using population based payments, episodes of care and quality-based payments," write Slavitt and Wachino in a blog post. "In addition, states operate 30 health home programs that focus on coordinating care for people with chronic conditions like obesity, diabetes and mental health conditions. Over the last several years, sates have undertaken significant efforts through State Innovation Models, integrated care models, and delivery system reform incentive programs to create alignment with physicians and hospitals to provide the highest quality of care. And we have proven that when we and states dedicate ourselves to changing the delivery of care, we get results." Read the final rule here.

There are day-to-day blocking and tackling tactics that every healthcare organization should be doing right now to reasonably address the current security threat landscape.

Officials uncovered 'significant risks' and irregularities during rollout, raising concerns about a viable final product, a spokesperson says.