OVERVIEW
We spent last week at HIMSS in Orlando attending education sessions, meeting with clients and walking the exhibit floor talking with vendors. HCIT policy emphasis was on digesting recent legislative accomplishments instead of any new major announcements or initiatives.
On the health policy front, several themes dominated the event:
1. Future of the Affordable Care Act and MACRA
2. Interoperability and Implementation of 21st Century Cures
3. Role of Telemedicine
Importantly, administration and Congressional representatives past and present emphasized a much lighter regulatory touch for HCIT Gone is the notion of overly prescriptive and process oriented requirements (read: meaningful use) in favor of industry led initiatives that meet broad goals.
Also, providing as much accommodation to small and mid-size physicians practices (and by implication other provider types) in their HCIT use is a top priority for policy leaders.
Add that new policy direction to the combined effects of uncertainty over the future of the ACA and other slowing macro trends and the HCIT sector should not look to federal policy as a demand driver, implementation of MACRA notwithstanding.
Please don't hesitate to call or write with any questions or if you would like the complete verbal download of our experience.
THE FUTURE OF THE ACA AND MACRA IMPLEMENTATION
Key Takeaways:
- MACRA was bipartisan legislation and not likely to be affected by political climate. Payment and delivery reforms inspired by the ACA are also likely to remain and proliferate, albeit without the mandates favored by the Obama administration.
- Eliminating the hospital EHR incentive program – Meaningful Use – and replacing with something similar to MACRA is a Congressional priority.
- CMS leadership past and present repeatedly stressed the slow rollout of MACRA which they call “pick your pace.” The administration was particularly keen to assure small, rural and/or physician practices located in under resourced communities.
- Another priority for CMS is for the MACRA quality program to align with state Medicaid programs and commercial insurers.
- With respect to quality measures, there was near uniform agreement that CMS (and those it influences like Medicaid programs and commercial payers) should abandon and avoid future use of process measures in favor of outcomes measures.
- We note that CMS administrators, when faced with specific questions about MACRA implementation, often struggled with their responses. Their confusion may just be a function of the expertise of the person fielding the question or it could be that they are still building the airplane midflight. We suspect the latter.
- Most current federal employees wanted nothing to do with speculation about the future of the ACA. Former Acting CMS Administrator Andy Slavitt and former CMS Administrator Mark McClellan, however, were more forthcoming. Slavitt believes that repeal of the ACA is not a fait accompli. McClellan thought that there would be repeal because Republicans consistently included it in their platform for years. The content of that repeal is less clear.
- Medicaid expansion in one form or another is here to stay but will emphasize social determinants of health more than health care services.
INTEROPERABILTY AND IMPLEMENTATION OF 21st CENTURY CURES
Key takeaways:
- Former Acting CMS Director Andy Slavitt had some strong words for major EHR vendors who were resisting interoperability.
- Interoperability remains a major goal of Congressional leaders and CMS. The 21st Century Cures bill “worked around the edges” by giving the Office of the Inspector General to enforce interoperability standards.
- In the end, it will be up to the private sector to make it happen through open APIs and enforced interoperability standards.’
- Privacy and security continues to be an issue. HIPAA is an oft cited reason for not sharing data and there is pressure to modernize the law.
- Although most policy leaders felt that recent legislation like MACRA and 21st Century Cures encouraged private sector innovation to disrupt the silos lamented by Slavitt, everyone seemed to agree that 2017 would probably be a slow year when it came to investment and innovation due to the political uncertainty.
TELEMEDICINE
Key takeaways:
- For policy makers, telemedicine was clearly a priority – a fact not exactly reflected by the exhibit space dedicated to relevant vendors.
- The proliferation of telemedicine supports a bipartisan goal of greater access to care especially in the home.
- The private sector is leading the way in use of telemedicine as are Medicaid programs.
- An interstate licensure compact will begin issuing multistate medical licenses in March that will permit physicians to practice telemedicine across state lines.
- Payment parity remains an issue.
- The barrier for Medicare reimbursement is the Congressional Budget Office which treats telemedicine “visits” as accretive and not a substitute for office visits. Administration and Congressional representatives all encouraged conference attendees to send in research that would defeat the CBO’s arguments.
Field Notes:
- “At the onset, most physician practices will start in MIPS and not APMs [to comply with MACRA].”
- “There aren’t that many ideas [to repeal and replace} and in the Senate, Medicaid expansion is the issue.”
- “Open API is greatest opportunity.”
- “[Whatever happens with the ACA] does not mean there won’t be administrative actions in Medicaid.”
- “{In primary care} somebody somewhere is purposefully screwing things up and CMS had a role.”
- “One of the biggest opportunities is through state-based reforms and payment reforms and do more to shift the resources to target patients who could benefit from non-medical interventions.”
- “Industry is still silo-ing data for business reasons. Their products are still not doing what patients and doctors want.”
- “Organizations looking at IT systems to maximize revenue and information block is not a good business model.”
- “In 2017, buying will be slow. Once uncertainty clears, it will be back.”
- “Cerner and Epic work when you are in the hospital but not when you are home.”
- “Need to get to place [with Medicare] where only the patient matters.”
- “Need to get away from a legal explanation of why we cannot share [data].”
- “Need to do something about hospital Meaningful Use.”
- “{Limits on disclosure on substance abuse] needs to harmonize with HIPAA. It did not make it into the Cures Act because it is so controversial.”
- “You might want to take a look at the CHRONIC Act”
- “Let 2017 be the year for telehealth parity.”
- “Shift away from services to outcomes is a big challenge.”
- “Distance does not have to be a barrier [to care.]”
- “We now have a nationwide installed base for interoperability.”
- “Tech community wants clarity and certainty. Want to know where the puck is going. Want to be involved.”
- “Providers need feedback more than once a year.”
Call with questions.
Emily Evans
Managing Director
Health Policy
@HedgeyeEEvans
