Mostashari Touts Health IT in Light of Sequester-fueled EHR Program Cuts

Donning his signature bow tie at HIMSS13 in New Orleans, National Coordinator for Health Information Technology (ONC) Farzad Mostashari spent much of his public talking time revealing data points that underscored the benefits of health IT, including the government's EHR incentive program. During his keynote speech Thursday morning, he stressed the importance of interoperability and poked fun of both curmudgeonly EHR cynics and journalists who question non-government data that suggests docs aren't happy about their EHRs.

But what he didn't spend much time chatting about, save for a response to a reporter's questions during an onsite press briefing, is the sequester-induced 2 percent cut in meaningful use payments to providers and $3 million cut to ONC. And it's that news that concerns many physician practices the most; namely those investing thousands of dollars in EHRs and data-analytics technology.

Elizabeth Holland, director of the HIT Initiatives Group in CMS' Office of E-Health Standards
and Services, reportedly confirmed earlier that Medicare meaningful use payments will be
subject to mandatory cuts under budget sequestration, including a 2 percent cut to payments that are processed after April 1. Fortunately, the cuts will not affect Medicaid meaningful use payments.

Additionally, under the sequester, ONC will receive a $3 million budget cut, reducing its funding to $57 million, Mostashari said.

"It's going to hurt providers who are going to see a 2 percent cut to all their incentive payments," Mostashari told reporters Wednesday. "Medicaid thankfully is spared."

Regulatory expert Jason Fortin, senior adviser of discovery and development for Miami-based Impact Advisors, noted that the cuts would mostly affect providers attesting to meaningful use if this is their first year, as the biggest piece of the $44,000 payment to providers is in the first $18,000 check. But although 2 percent only amounts to "a couple of hundred dollars" for providers, "they still could find a use for that money."

What concerns Robert Tennant, senior policy advisor for the MGMA, more than the 2 percent cut are the other cuts.

"It's not just cuts to meaningful use payments," Tennant told Physicians Practice. "It's also cuts to Medicare payments, and [CMS Acting Administrator] Marilyn Tavenner indicated that it's going to be a 5 percent administrative cut to CMS. The overall payments from Medicare are going to go down 2 percent."

Such cuts could affect outreach and education efforts to practices. One way that might translate: If CMS staff aren't able to fly to as many conferences in order to present educational sessions, providers might not be as well-equipped with the knowledge they need to fully implement EHRs.

ONC, HHS Outline Ambitious Health IT agenda

Early on Wednesday, CMS Acting Administrator Marilyn Tavenner and Mostashari presented an ambitious health IT agenda for 2013, as well as a request for information (RFI) calling for healthcare industry stakeholders to weigh in on existing health IT policies. At the heart of the government's goals: a push toward interoperable data exchange, or the exchange of data that is understandable by its transmitters and recipients.

What this means for physician practices: Expect policies that require you to spend more time with technology, and especially EHRs, to provide value-based, cost-effective care for patients.

"The administration is absolutely committed to health information technology as a foundation for payment and deliver models," Mostashari told reporters. "And we cannot succeed in shifting payment models from volume to value without having a … platform for information management and sharing."

Here are just a few of HHS and ONC's goals for the coming year:

• To have 50 percent of physician offices using EHRs and 80 percent of eligible hospitals receiving meaningful use incentive payments by the end of 2013.

• To increase the emphasis on interoperability. HHS said its RFI issued today fosters that effort by seeking public input about a variety of policies that will strengthen the business case for electronic exchange of data across providers to ensure patients' health information will follow them seamlessly and securely wherever they access care.

• To enhance the effective use of electronic health records through initiatives like the Medicare Blue Button initiative. Medicare beneficiaries can access their full Medicare records online today.

• To continue to implement Stage 2 of meaningful use.

• To take new steps to ensure the integrity of the program is sound and technology is not being used to game the system.

EHR adoption has tripled since 2010, increasing to 44 percent in 2012, and computerized physician order entry has more than doubled (increased 168 percent) since 2008, according to a media release.

"The 2014 standards for electronic health records create the technical capacity for providers to be able to share information with each other and with the patient," said Mostashari, via press release. "Through the RFI, we are interested in hearing about policies that could provide an even greater business case for such information sharing."

In addition to seeking public input, the RFI also discusses several potential new policies and ideas to accelerate interoperability and exchange of a patient's health information across care settings so that they can deliver better and more affordable care to their patients.

The deadline for comments for the RFI is April 21, 2013.