According to news reports, the change from the Obama to Trump administrations has created a void at the federal level. Hundreds of key positions remain unfilled and many programs are treading water, awaiting direction from the top, an exception being the Department of Health and Human Services (HHS). Here’s a quick look at some of the progress that’s been made so far concerning health information technology (health IT).
Unlike a lot of other agencies, many of HHS’ top jobs are filled — especially those related to health IT. Tom Price, MD, is now the HHS secretary. Seema Varma is in charge of the Centers for Medicare and Medicaid Services (CMS), which plays pivotal roles in adoption of health IT standards and use of health IT. John Fleming, MS, is the deputy assistant secretary for health technology reform, a newly created position. Donald Rucker, MD, now heads the Office of the National Coordinator for Health Information Technology (ONC). Genevieve Morris, formerly a senior director at Audacious Inquiry, has assumed the role of ONC’s principal deputy national coordinator for health information technology. Scott Gottlieb, MD, has been confirmed as commissioner of the Food and Drug Administration, which has some health IT responsibilities, especially when it comes to medical devices.
To be sure, other top jobs are waiting to be filled at HHS. However, the department seems to be ahead of the curve when it comes to the hiring and confirmation process for positions related to health IT.
We are beginning to see progress in programs and regulations related to health IT and fighting the opioid crisis.
Tweaking health IT requirements and reducing physician burden.This is happening right out of the gate. An example is CMS’ Notice of Proposed Rulemaking for the Fiscal Year (FY) 2018 Hospital Inpatient Prospective Payment System (IPPS). CMS proposes increasing operating payment rates by 1.6% for general acute care hospitals that are paid under the IPPS rule, provided they successfully participate in the Hospital Inpatient Quality Reporting Program and engage in meaningful use (MU) of electronic health records (EHR). The proposed rule would eliminate payment adjustments for eligible hospitals that demonstrate that MU compliance is not possible under the ONC’s Health IT Certification Program. In addition, CMS also is suggesting more general MU program changes. For 2018, the agency would modify the EHR reporting periods in both Medicare and Medicaid to at least any continuous 90-day period during the calendar year instead of from the full year requirement.
Moving forward with health IT standards and policy. The Trump administration is rapidly moving ahead with staffing the new HIT Advisory Committee. Members are to be announced in July. The Committee was created under the 21st Century Cures Act, which sunsets and combines the existing HIT Policy and Standards Advisory Committee. Dr. Thomas Price, HHS Secretary, said as much in his keynote at the recent Health DataPalooza. He told the audience that a burdensome and rigid regulatory environment may mitigate the benefits inherent in health IT and the exchange of health care data. He also emphasized a hands-off approach to health IT oversight. That said, regulations cannot and will not go away entirely. While there may be a reduced number of regulations, HHS may need to piggyback on required rule making — such as the IPPS — for issuing some of its health IT policy guidance.
Health IT is important, but… The Trump Administration has offered several signals that health IT is important. For example, top positions related to health IT appear to have headed HHS’ hiring queue. A new, very high-level position — deputy assistant secretary for health technology reform — was created. No time was wasted in getting the HIT Advisory Committee off the ground. That said, the Administration’s new budget for fiscal year (FY) 2018 indicates a big budget cut for ONC. HHS’ Budget in Brief shows a $22 million cut for ONC, which will be left with $38 million for FY 2018,and a staffing reduction of 26, leaving162 employees. According to the document, the funding will be used to focus on two priorities: interoperability and EHR usability.It also suggests monies will be available for activities specified under the 21st Century Cures Act, including funding the HIT Advisory Committee; curbing information blocking; prioritizing work on standards coordination, implementation, and testing; and developing pilots to accelerate industry progress towards interoperability. It’s possible that the Trump Administration is negotiating; that is, going in low for an opening bid when it comes to the budget, knowing that things will be bargained upward. Many speculate that this budget is dead on arrival and things might change as the budgeting process unfolds—especially in light of the outpouring of support for ONC by such stakeholders as the Healthcare Information and Management Systems Society (HIMSS); the College of Healthcare Information Management Executives (CHIME): the American Health Information Management Association (AHIMA); and the American Medical Informatics Association (AMIA). While it is too soon to tell the impact of next FY’s budget on ONC and other health IT activities in HHS, ONC still has a key role to play if things stay as they are.
MACRA tweaks are likely. Secretary Price has already asked for suggestions for ways to change physician reimbursement. He is apt to get an earful once physicians actually have to start complying with the EHR use and quality reporting requirements of the Medicare and CHIP Reauthorization Act (MACRA). A Deloitte survey found that half of doctors had never even heard of the new payment law. Once MACRA’s aggressive compliance timelines and complicated requirements start to register with the provider community they are likely to demand changes, to which HHS is apt to be responsive. Physician pushback works. We have seen this before with other major changes, such as MU and ICD-10.
A new head tweak master is created? John Fleming, MS, is the deputy assistant secretary for health technology reform. It is a newly created position whose duties have not been fleshed out. Recently, Secretary Price asked stakeholders to envision a reorganized HHS and what that may look like. Connecting the dots and reading the tea leaves, will health IT functions be consolidated in this shop? Will Fleming be in charge of administering and tweaking MU, MACRA and other health IT-related policies?
The opioid epidemic will continue to drive policy and programmatic initiatives. Sadly, the opioid epidemic is not ending anytime soon. The high-level interest in the topic and its scope will continue to create new policies and programs at HHS. Health IT will be a key part of the solutions that will arise, with increasing emphasis for PDMP interoperability and use of electronic prescribing for controlled substances.
Point-of-Care Partners is following policy and regulatory developments related to health IT. Stay tuned to HIT Perspectives and blog posts for updates.
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