Government & Policy

Medical practices spend an average of 785 hours per physician and $15.4 billion annually reporting quality measures to Medicare, Medicaid and private payers, according to a new report in Health Affairs. The study, led by researchers from Weill Cornell Medical College and funded by the Physicians Foundation, looked at the quality reporting efforts of primary care, cardiology, orthopedic and multi-specialty practices, polling 1000 of them (250 of each type), drawn at random from the membership rolls of the Medical Group Management Association. Their findings suggest that, while "much is to be gained from quality measurement, the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report," researchers said. [Also: Slavitt, DeSalvo: Health IT has to work better for doctors] Practices reported spending 15.1 hours per week per physician wrangling quality measures -- 2.6 hours each week for physicians, with the rest of the work going to nurses or medical assistants. About 12 of those hours were spent logging data into medical records solely for quality reporting. Some 80 percent of practices said they spend more time managing quality measures than three years ago. Almost half said that's become a significant burden. But just 27 percent thought those measures necessarily correlated with quality care. Beyond the time invested, the dollars add up too. Weill Cornell researchers found that practices spent $40,069 per physician each year on quality reporting – totaling $15.4 billion annually. "The cost to physician practices of dealing with quality measures is high and rising," researchers said. "On top of the obscene waste of billions of dollars each year on quality measures, the most alarming thing about this study of MGMA member practices is that nearly three-fourths of the groups reported being measured on quality measures that are not clinically relevant," said Halee Fischer-Wright, MD, MGMA's president and CEO, in a statement. "The vast majority also stated current measures are useless for improving patient care," she added. "This study proves that the current top-down approach has failed. It serves no purpose to have over three thousand competing measures of quality across government and private initiatives." While care quality is essential and reporting standardization is critical, "if measures don't improve patient care, it’s an exercise in futility," said Fischer-Wright. "As the largest contributor to the problem, the federal government needs to get out of the business of dictating patient care through wasteful mandates and create simplified systems to support medical practices in improving quality across the country." As HIMSS16 in Las Vegas this past week, officials from the Centers for Medicare and Medicaid Services emphasized that quality measures would continue to be a key component in CMS' reimbursement programs. [Also: Meaningful use will still be part of MIPS reimbursement, CMS says] Kate Goodrich, MD, director of CMS' Center for Clinical Standards and Quality, said new payment rules under the Medicare Access and CHIP Reauthorization Act, or MACRA, would reimburse physicians based on a composite performance score factoring in quality measures (30 percent), resource use (30 percent), clinical practice improvement activities (15 percent) and meaningful use of information technology (25 percent). "Our intent is to have a single, unified program," she said, while acknowledging the need for flexibility and avoiding a one-size-fits-all approach: "We know physician practices are very different from one another." Earlier in the week, CMS Acting Administrator Andy Slavitt said the agency has been listening more intently than ever to physician feedback, working with those on the front lines to understand their pain points. He cited actual quotes from physicians, including one who said, "Most of what I'm doing during the day is entering data into the EHR." While offering few policy specifics, Slavitt seemed to indicate that's a message that's resonating with CMS. Doctors are "not describing problems we don't know how to solve," he said. "Job one is to bridge the gulf between our public policy work and what's actually happening with patient care. That has to become an integral part of how we do things." Twitter: @MikeMiliardHITN

U.S. Department of Veterans' Affairs CIO LaVerne Council said last week that the VA needs to reconsider whether its proprietary Veterans Information Systems and Technology Architecture is the best electronic health record for its more than 1,200 healthcare sites. Council explained during testimony to U.S. House appropriators that changes in the VA's healthcare delivery plan, such as emphasis on mobility, security and women's health, as well as connections with private sector providers, are forcing the reconsideration of VistA. Specifically, Council said it was time to "take a step back" from the planned modernization of the VistA health record and announced VA plans to review whether it should continue upgrading VistA or turn to a commercial off-the-shelf product, much the way the Department of Defense elected to forego its in-house Armed Forces Health Longitudinal Technology Application, aka AHLTA, and is replacing it with a Cerner EHR. [Like Healthcare IT News on Facebook] “We have not made up our minds about VistA,” Council said. When asked during a separate hearing last week by Montana Democrat Sen. Jon Tester why it’s taking so long to either fix or replace VistA, VA undersecretary David Shulkin, MD, explained that Council “has gone in with her private sector background and really challenged all of the assumptions that frankly have led to an underperforming part of the organization.” Council and Shulkin’s comments come after the Government Accountability Office published recommendations in Late February that both VA and DOD “develop and compare the estimated cost and schedule of their current and previous approaches to creating an interoperable electronic health record and, if applicable, provide a rationale for pursuing a more costly or time-consuming approach.” Twitter: @HealthITNews

Whereas a democrat would be more prone to simple tweaks, a republican would opt for tax credits, Romney said, acknowledging that since Obamacare is the law of the land it would would be hard to go back to his preferred model under which the states decide how to insure their citizens.

Barely a year after announcing its ambitious plan to tie reimbursement to quality of care, the U.S. Department of Health and Human Services announced Thursday that 30 percent of Medicare payments are now tied to alternative payment models, such as ACOs.  

Donald J. Trump, the frontrunner in the race to become the Republican presidential nominee, today released a very broad outline of a plan with few details that he, if elected president, would seek to implement to replace the Affordable Care Act.

While the former presidential candidate called the 2016 race anything but over, as for his own entry into the race, the answer is 'no.'

Providers range from linking some payments to the effective management of a population to full population-based management.

A new agreement with FHA will allow DirectTrust's federal partners to operate their Direct implementations within its Security and Trust Framework.

The development of standards through the lab will help ONC further develop interoperability standards, official says.

The Healthcare Leadership Council has identified six healthcare reforms that should be implemented by the White House, Congress and the healthcare industry to reform healthcare; it was announced last week at a Capitol Hill briefing and in a report highlighting the changes. For starters, nationwide health information interoperability in the private sector should be achieved by December 31, 2018, the group said. The group also targeted the Food and Drug Administration, saying reforms that focus on reducing administrative burdens placed on the organization should be enacted so the FDA can better bring innovative treatments and technology to patients. [Also: Hollywood Presbyterian gives in to hackers] “These steps aren’t revolutionary, but they're transformative,” said HLC President Mary R. Grealy, in a statement. “Innovation is too often put on the backburner when we discuss healthcare policy, but it’s critical to elevating health system value and to address quality and cost challenges." The Centers for Medicare and Medicaid Services also needs to improve the Enhanced Medication Therapy Management Model to reach its goal of improving patient health and should implement best practices for Medicare, insurers and healthcare providers to improve care for the chronically ill, the group said. The federal government should reform outdated physician self-referral and anti-kickback statutes and expand Medicare payment waiver policies to protect against fraud and abuse, while improving care coordination. Cybersecurity also needs focus, the group said, pointing to Congress and the states to standardize privacy laws and increase access to patient data. The recommendations are compiled from the HLC's National Dialogue for Healthcare Innovation initiative – a collaboration of patient advocacy leaders, drug company representatives, patient advocacy leaders, patient groups and other industry experts that convened over the course of a few months. David Barrett, CEO of Lahey Clinic and Bill Hawkins, chairman and CEO of Medtronic, co-chaired the group. [Like Healthcare IT News on Facebook] “There's a widespread understanding that, for all of our healthcare system’s considerable strengths, we need to make strides in providing high-quality care at sustainable costs," Susan DeVore, president and CEO of Premier, Inc. and HLC chair, said in a statement. "The six steps on which we have reached agreement will move us significantly in that direction." HLC has begun meetings with congressional leaders about the recommendations and will continue the conversations in the coming weeks. The compiled recommendations were produced by a partnership with NORC, the independent public policy research organization at the University of Chicago. Twitter: @JessiefDavis