Mostashari: No cap on EHR incentive payouts

There are no set appropriations for how much the federal government can spend on rewarding providers who adopt and use electronic health records under the Medicare and Medicaid meaningful use EHR incentive program, according to National Coordinator for Health IT Farzad Mostashari, MD.

"Whoever qualifies, gets paid; there's no hard cap," said Mostashari, who gave a keynote at the Annual Policy Summit for the Health Information Management and Systems Society (HIMSS) on Wednesday.
 
Mostashari said the federal government estimates it will pay out around $20 billion in incentives before the program shifts to a penalty in 2015, but there is no fixed budget set in the HITECH Act that mandated the program. The government recently announced it has paid out nearly $7 billion since the program began in 2011.
 
[See also: Government EHR incentives near $7B.]
 
The federal health IT czar said he couldn't imagine health IT advancement – which enjoys widespread bipartisan support – losing the backing of Congress after the election, no matter the party in control. 
 
It would be hard to picture Congress cutting or capping the program after doctors and hospitals have made major investments in health IT "on the good word of Congress," he said. 
 
An attendee of the HIMSS Policy Summit – a sort of pep rally for HIMSS members to promote HIT on the Hill – recommended that Congress all be encouraged to use Blue Button to access their personal health data. This would "crystalize quite clearly" where things stand with regard to health IT today. We need more time and support, the attendee said, and Mostashari and other attendees agreed.
 
Mostashari praised the meaningful use incentive program, noting that "we've made great steps." He predicted that Stage 2, set to begin in 2014, will bring about even more "incredible progress."
 
The use of electronic health records is "ulitmately about population health," Mostashari said. "You have to care more about the people who didn't walk into your door, than those who did." The meaningful use program is intended to go from measuring quality at the start, to accounting for population health. "That's why doctors are doing what they're doing, [and] that's why we're doing what we're doing," he said of federal regulators.
 
At a visit to the Cleveland Clinic recently, Mostashari said he observed health data exchanged between the clinic and other local facilities, using compatible coding that transferred the data easily. "They do it all day, every day," he said. "So don't tell us that exchange isn't happening."
 
[See also: Stage 2 MU released at last.]
 
Two years ago, the industry wasn't there, he said of health information exchange. The patient information wasn't packaged and ready to code medications and lab reports in the same record. But things have changed, Mostashari added. He praised the industry and the  marketplace for pushing it forward.
 
The industry came together with a consensus and pilots and working groups, which resulted in the meaningful use Stage 2 rule, Mostashari said. "We're light years ahead of where we could possibly have been in Stage 1," he added, noting that he believes meaningful use Stage 2 will necessitate a push from the industry for health information exchange standards. 
 
It will be important in the near future to tap into "the biggest underused resource – the patient," Mostashari said. Providers will have to "be sticky," and attract patients to their services because patients will no longer be limited to the provider that holds their health information.
 
Said Mostashari, speaking to doctors as a doctor: "We have to make them want to come to us."