Responding to a feedback request from Senators on Capitol Hill regarding health IT adoption, the College of Healthcare Information Management Executives called for a one-year pushback of the Stage 2 meaningful use deadline and defended the efficacy of the federal incentive program.
In a May 6 letter
addressed to six Senators who have recently voiced skepticism over the current state of health IT, CHIME CEO Russell P. Branzell and CHIME Board Chair George T. Hickman
wrote that a one-year extension of Stage 2 would "maximize the opportunity of program success."
With many providers struggling to meet Stage 1 requirements on top of additional regulations outlined in rules such as HIPAA and ICD-10
, the industry needs the extra breathing room, CHIME officials say.
The extra year "will give providers the opportunity to optimize their EHR
technology and achieve the benefits of Stage 1 and Stage 2," wrote Branzell and Hickman. "It will give vendors the time needed to prepare, develop and deliver needed technology to correspond with Stage 3; and it will give policymakers time to assess and evaluate programmatic trends needed to craft thoughtful Stage 3 rules.”
In calling for the Stage 2 extension, CHIME defended much of the federal incentive program’s progress to date, arguing that fundamental shifts in health IT adoption and EHR product capabilities have been made possible through meaningful use.
“While we share some of your concerns with the current state of interoperability
, we strongly believe that EHR incentive payments under the policy of meaningful use have been essential in moving the nation’s healthcare system into the 21st Century,” officials wrote. “Through the EHR Incentive Payments program, CMS
have begun to mitigate a fractured and incompatible state for EHRs.”
The response comes amid concerns levied by six Senators — John Thune, R-S.D.; Lamar Alexander, R-Tenn.; Pat Roberts, R-Kan.; Richard Burr, R-N.C.; Tom Coborn, R-Okla.; and Mike Enzi, R-Wyo. — that the current direction of the HITECH program is flawed. The Senators' white paper
released April 16 outlines several concerns including increased healthcare costs; torpid momentum toward interoperability; lack of administration oversight to properly prevent fraud and waste; patient privacy and long-term program sustainability.
"It is unclear whether the HITECH Act
has expanded the use of health IT in a meaningful, effective way," the Senators wrote. "We have significant concerns with the implementation of the HITECH Act to date, including the lack of data to support the Administration's assertions that this taxpayer investment is being appropriately spent and actually achieving the goal of interoperable health IT."
The Senators cited the $35 billion in incentive payments and grants authorized by ARRA
, nearly $12.7 billion already paid out by CMS as of February. Nearly $1.2 billion was paid in December of 2012 alone. "With so many dollars flowing out of CMS, Congress has the fiduciary responsibility to ensure that these taxpayer dollars are being used to efficiently accomplish the end goal of reduced health care costs through the appropriate sharing and use of health information," the white paper reads.
CHIME officials stated that the Senators' report "highlights a number of fair and responsible criticisms of the program," echoing many of the concerns CHIME has voiced in the past three years. However, "given the nation’s increased adoption of EHRs, the increased investments in interoperable solutions and the early-stage transformations encountered every day by our members, we remain convinced that the trajectory set by meaningful use is the correct one," wrote Branzell and Hickman.
CHIME also urged Congress to request an update from ONC regarding what technologies, architectures and strategies exist to mitigate patient matching errors; seek feedback from the public via congressional hearing or other formal commenting mechanism; and determine how current work at the S&I Framework could be leveraged to address the foundational challenge of patient data-matching.
Responding to a section of the white paper on audits and program integrity, CHIME said CIOs understand the desire to ensure that incentive payments are going to those who have qualified to receive them, but this intent must not result in unreasonable auditing efforts that are poorly structured, inconsistent or lack uniform criteria. “We ask that Congress ensure CMS audits are efficient and effective without overburdening providers,” the letter stated.