Final Rule on ACOs encourages EHR adoption but eliminates “meaningful use” requirement

The Centers for Medicare and Medicaid Services (CMS) announced today, October 20, 2011, that the use of certified electronic health records (EHRs) will be the highest-weighted quality measure for an Accountable Care Organization (ACO) under the new Medicare Shared Savings Program.

ACOs are designed to encourage primary care doctors, specialists, hospitals, and other health care providers to coordinate their care. The CMS Final Rule on ACOs bases the amount of shared savings that an ACO may receive for its performance on four domains of quality: 1) quality standards on patient experience; 2) care coordination and patient safety; 3) preventive health; and 4) at-risk populations.  To earn shared savings the first performance year, providers must report across all four domains of quality, which include a total of 33 quality measures.  Providers will begin to share in savings based on how well they perform on 23 of the 33 quality measures in the second performance year and on 32 of the 33 measures in the third performance year. 

Measure 20 of the 33 quality measures requires ACOs to report the percentage of primary care providers (PCPs) who successfully qualify for an EHR Incentive Program payment.  CMS expanded the scope of PCPs who can be counted in this measure by eliminating the requirement that the PCP be a “meaningful EHR user” as defined in 42 C.F.R. § 495.4 of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.  CMS stated that it “decided to . . . expand [measure 20] to include any PCP who successfully qualifies for an EHR Incentive Program incentive rather than only including those deemed meaningful users.”

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The FTC’s Identity Theft Red Flags Rule: Catching the uninsured in the act of medical services theft

Article Summary:  The Federal Trade Commission’s Red Flags Rule for identity theft applies to most health care providers according to the FTC’s current guidance. The FTC makes a clear attempt under the Rule to regulate medical identity theft, as opposed to credit identity theft. The result is that the FTC will have regulatory authority in an area that the Department of Health & Human Services, since the issuance of the Red Flags Rule in late 2007, has seen fit to strengthen under the HITECH Act of 2009, through both enhanced security protections and breach notification requirements. Further, the HITECH Act put into motion aggressive health information technology reform that also will likely address medical identity theft. Do we really need another federal agency regulating the privacy and security protections that health care providers provide for medical records? This article summarizes the key components of the Red Flags Rule that will draw most health care providers into its reach and discusses how current health care reforms may impact favorably on preventing medical identity theft.

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HIT Standards Commitee Work Groups to Focus on Data Exchanges that Constitute Meaningful Use

Under the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act), the Office of National Coordinator for Health Information Technology (ONC) and the United States Department of Health and Human Services (HHS) are vested with authority to further define “meaningful use” as it relates to qualifying to receive stimulus funds for the adoption and implementation of electronic health records (EHRs). ONC’s Health Information Technology (HIT) Standards Committee is vested with authority under HITECH to propose a national HIT standard for EHRs that takes into consideration “meaningful use” and interoperability. In order to meet the HITECH Act’s December 31, 2009 deadline for coming up with this standard, however, the HIT Standards Committee must begin its work before “meaningful use” is further defined. Accordingly, during its first meeting on May 15, 2009, the HIT Standards Committee identified three primary data exchanges that would be integral to “meaningful use.” These data exchanges are: 1) Clinical Operations; 2) Quality; and 3) Security. The HIT Standards Committee formed a work group for each of these types of data exchanges.

Clinical operations HIT data exchanges would include e-prescribing and medication management, lab ordering and results, and a clinical summary exchange. The clinical summary exchange would be critical to enabling physicians and practitioners unfamiliar with a patient’s history to retrieve the most important facts quickly. For example, a clinical summary might include the patient’s problem list, medications, allergies, and text based reports such as operating notes, diagnostic testing reports, and discharge summaries.

Quality HIT data exchanges might include information about patient outcomes and treatment plans, patient health behaviors, and physician and practitioner medical decision making.

Secure HIT data exchanges would necessary require considerations of transport, messaging, authentication, authorization, and auditing.

The first meeting date for each work group is as follows: Clinical Operation — June 9, 2009, 10 am to 12 Noon EDT; Quality work group — June 10, 2009, 11 am to 1 pm EDT; Security work group — June 17, 2009, 11:15 am to 1:15 pm EDT.

John D. Halamka, M.D., Vice Chair of the HIT Standards Committee, provided a summary of the April 15, 2009 HIT Standards Committee meeting on his blog entry for May 15, 2009. Mr. Halamka also summarized the first meeting of the HIT Policy Committee on May 12, 2009, on his blog here.

National Committee on Health & Vital Statistics Issues Report on “Meaningful Use” Hearing

On May 18, 2009, the National Committee on Health & Vital Statistics (NCHVS) issued a 32-page report on the public hearing that the NCHVS held on April 28-29, 2009, to solicit testimony to help define and clarify the the term “meaningful use” under the ARRA. The report digests the testimony and organizes it into five categories of questions for the Office of National Coordinator (ONC) and Centers for Medicare and Medicaid Services (CMS). The categories are: 1) Vision of Health and Health Care Transformed; 2) Meaningful Use Capacity; 3) Path to Meaningful Use; 4) Certification and Meaningful Use: EHR Product Certification; and 5) Measuring Meaningful Use. Appendix B of the Reports lists the 100+ participants who provided oral and written testimony for the hearing. To read the report click here.