Wednesday, December 16, 2015

Summary of the HIT Policy Committee Report to Congress

Below is a summary of the HIT Policy Committee Report: "Challenges and Barriers to Interoperability" submitted to Congress today:

The Consolidated and Further Continuing Appropriations Act, 2015 was signed by the President on December 1, 2014. It reads in part:

Interoperability.--The agreement directs the Health IT Policy Committee to submit a report to the House and Senate Committees on Appropriations and the appropriate authorizing committees no later than 12 months after enactment of this act regarding the challenges and barriers to interoperability. The report should cover the technical, operational and financial barriers to interoperability, the role of certification in advancing or hindering interoperability across various providers, as well as any other barriers identified by the Policy Committee.

Past Health IT Policy Committee recommendations in the following categories of barriers to interoperability:

  • Lack of universal adoption of standards-based EHR systems
  • Impact on providers’ day-to-day workflow
  • Complex privacy and security challenges associated with widespread health information exchange
  • Need for synchronous collective action among multiple stakeholders
  • Weak or misaligned incentives

Interoperability is defined as the ability of two or more systems to exchange information and the ability of those systems to use the information that has been exchanged without special effort. Although substantial interoperability amongst all stakeholders in American health care has not been achieved to date, there are pockets of meaningful health information exchange developing.

The following new recommendations were developed by the Interoperability Task Force of the HITPC to build upon work that ONC has undertaken to identify solutions to some of the barriers identified within this report, most notably, ONC’s updated version of the Shared Nationwide Interoperability Roadmap (Interoperability Roadmap).

Three Recommendations

Develop and implement meaningful measures of HIE-sensitive health outcomes and resource use for public reporting and payment

HIE-sensitive measures are those which require health information to be exchanged and effectively used in order for the applicant to earn high scores. In order to enhance the strength of incentives that drive interoperability, a set of specific measures should be developed that focus on the delivery of coordinated care, facilitated by shared information across the entire health team (including the individuals and families) and throughout the continuum of care settings. An example of an HIE-sensitive measure would look at medically unnecessary duplicate testing. Payers could provide incentive clout by declining to reimburse for medically unnecessary duplicate testing.

Develop and implement HIE-sensitive vendor performance measures for certification and public reporting

While use of HIE-sensitive quality and value measures for provider organizations may serve as an indirect incentive for vendors to improve their systems, we believe that direct measures of HIE-sensitive vendor performance will bolster market forces behind vendor business practices that promote interoperability. Today, purchasers of EHR systems lack such measures to inform purchasing decisions or to use as a lever to put pressure on vendors to improve. Although vendors have strong incentives to pass the interoperability requirements for EHR certification, this process is “one-time” and occurs in a lab. It has not been shown to translate into interoperability that is affordable or easy to implement in the field.

Accelerate Payment Incentives for Interoperability: Set specific HIE-sensitive payment incentives that incorporate specific performance measure criteria and a timeline for implementation that establishes clear objectives of what must be accomplished under alternative payment models

Payers have existing mechanisms through which to incentivize providers to meet HIE-sensitive outcome measures, and Medicare is the logical payer to lead such efforts (particularly as CMS operationalizes new payment requirements under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). We note that these measures do not require defining interoperability as a new domain of performance incentives as they could easily be incorporated into incentive programs that target dimensions of provider performance that are HIE-sensitive, such as care that is coordinated, high-value, and safe, as well as integrated across the health and social services continuum. For example, a payment policy that denies claims for medically unnecessary duplicate testing for high-cost imaging would require coordination, or at least awareness, of orders and results by all providers involved in the care of an individual patient. Providing a roadmap for specific HIE-sensitive performance measures for future payment incentives, with enough lead time, will motivate and catalyze specific actions to speed the pace of achieving effective health information exchange that facilitates high priority use cases.

Friday, December 4, 2015

2016 CMS Quality Strategy

The goal of the updated CMS Quality Strategy is to shift Medicare payments from volume to value – tying 30% of traditional Medicare payments to alternative payment models and tying 85% of all traditional Medicare payments to quality or value by the end of 2016. The implementation of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a big opportunity to put a wide range of health care providers on the path to value through the new Merit-Based Incentive Payment System (MIPS) and incentive payments for participation in certain Alternative Payment Models (APMs). CMS says that the main purposes of the 2016 CMS Quality Strategy is to achieve the broad aims of the HHS National Quality Strategy (NQS) and the Triple Aim and to apply the strategy for shifting Medicare payments from volume to value: 
  • Better Care: Improve the overall quality of care by making health care more person-centered, reliable, accessible, and safe. 
  • Healthier People, Healthier Communities: Improve Americans’ health by supporting proven interventions to address behavioral, social, and environmental determinants of health and deliver higher-quality care. 
  • Smarter Spending: Reduce the cost of quality health care for individuals, families, employers, government, and communities. 
The 2016 CMS Quality Strategy goals reflect the six priorities set out in the NQS and identify quality-focused objectives that CMS can drive or enable to further these goals: 
  • Goal 1: Make care safer by reducing harm caused in the delivery of care. 
  • Goal 2: Strengthen person and family engagement as partners in care. 
  • Goal 3: Promote effective communication and coordination of care. 
  • Goal 4: Promote effective prevention and treatment of chronic disease. 
  • Goal 5: Work with communities to promote best practices of healthy living. 
  • Goal 6: Make care affordable. 
To meet these six goals CMS will: 
  • Measure the publicly reporting providers’ quality performance and cost of services provided; 
  • Provide technical assistance and foster learning networks for quality improvement; 
  • Adopt evidence-based National Coverage Determinations; 
  • Create incentives for quality and value; 
  • Set standards for providers that support quality improvement; and 
  • Create survey and certification processes that evaluate capacity for quality assurance and quality improvement