Post SGR-world could pose IT challenges

'Meeting stringent government program requirements means encountering practical challenges associated with technology'
By Sherree Geyer
10:10 AM
Frustrated doctor

Recent repeal of the Sustainable Growth Rate formula, which benchmarked reimbursement to the U.S. gross domestic product, could complicate things for IT systems already overburdened with federal regulations.

[See also: Reporting capabilities key for HIMSS Davies win]

"Physicians are swamped by regulations outside of meaningful use, like ICD-10, which places a huge burden on practices because of diagnosis codes," explains Robert Tennant, director of health IT policy at Medical Group Management Association.

"There was a mad scramble to get practices to report by Oct. 1," says Tennant. "The glide path needs to be longer and smoother or you'll run into the same problems physicians face now."

The Medicare Access and CHIP Reauthorization Act, which replaces SGR, establishes an automatic annual .5 percent raise in reimbursement between 2015 and 2019. Ongoing payments – tied to quality and improved access to care – are adjusted on a Merit-Based Incentive Payment System.

Chad Mulvany, director of healthcare finance policy, strategy and development at the Healthcare Financial Management Association, expects reporting requirements under MIPS to replicate those of Medicare's Physician Quality Reporting System.

"I'm inclined to believe reporting requirements will mirror PQRS," says Mulvany. "The shift will change the way quality measures are submitted or take on a different trajectory. There's a quality component that will replicate quality measures on PQRS and EHR.

Mulvany, who says that "high penalties won't go away; they get rolled into the new system," feels the promise of cross-platform standard interoperability could enhance the ability of providers to send and share quality data.

"Do I think data will flow freely as envisioned? No. Will it flow more freely than today? I should hope so," he says.

"You've seen the emphasis and attention of (interoperability) on the Hill," he says. "I suspect if the situation doesn't improve, it will generate more scrutiny about what our HITECH dollars bought us," he says.

Tennant calls interoperability "the buzz word of the day" and suggests language in HR2 (the bill that repeals SGR) could streamline reporting across multiple payer platforms.

"The commercial payers – the Aetnas, Blues, Humanas – have proprietary programs," says Tennant. "Some tie in. Some don't. Other than basic standards (the federal government) can't dictate how Humana records quality. There should be better streamlining, but as an industry we're hamstrung by proprietary approaches."

Tennant thinks "we've reached a tipping point" of custom systems that don't provide the timely, quality data physicians need to care for patients.

"The goal is to make reporting easy and automatic, to draw information from the EHR," he says. "Real-time data is how we'll get to an improved healthcare system. Technology is an enabler to provide better care."

Tennant sees quality indicators continuing to play a prominent role in federal regulation of healthcare IT.

"When you look at the direction that Medicare and healthcare is heading, it's away from paying for something done to patients and towards value that shows positive outcomes," he says. "At the same time, meeting stringent government program requirements means encountering practical challenges associated with technology, including keeping up with government mandates and programs."

Impediments to streamlined data access and reporting discourage physicians from using IT systems.

"They'll get to the point where they won't participate, which is not what we want. We want vendors to provide user-friendly platforms that enhance, not distract, from patient interaction," says Tennant, adding: "They're also challenged with 'change fatigue' where the focus has been more about meeting government requirements than patient needs. It's the 'check-the-box syndrome.'"

To meet the reporting standards mandated by an ever-changing regulatory environment, "look for a vendor who can be nimble and adopt changes from government without imposing costs to providers," he suggests. "Look for upgrades or government program changes included in maintenance fees to keep costs down and options, like data registry."

Another strategy is to "network with colleagues to find out what they're doing or what their experiences or successes are," says Tennant. "Colleagues in the trenches are far more likely to give unvarnished opinions than sales people. Look for commercial health plan quality improvement incentives. As Medicare and Medicaid wind down, the potential is that commercial plans may offer incentives or disincentives."

Lastly, he says to "look hard at what contracted plans are doing. Don't leave money on the table."