Online resources have published ample summaries of the final rules issued last week. CMS has put all the “meaningful use” regulations and official interpretations on a well-organized Web site, www.cms.gov/EHRIncentivePrograms. I see no value in posting one more recap of these details. My preliminary comments here are focused on implications instead.
As much as I appreciate the extraordinary work of selfless public servants who wrote them, the rules are not final. Federal regulators only defined the conditions for incentive payments through 2012 for a law that extends to 2016 and beyond. The rulemakers’ unexpected approach made a lot of sense because it proved they were listening carefully to public comments. By developing a phased approach with reasonable options, they addressed up-front concerns about roadblocks for getting started on the path to incentive payments. The initial hurdles are not the impediments that were feared.
However, providers and vendors who made public comments on the proposed rules should have been more thoughtful about getting what they asked for. The not-really-final rules resolve short-run concerns but don’t provide any detail about where the incentive program is headed in the long-run. Providers can now evaluate the odds of getting reimbursed for their up-front investments in EHR, but only for the first two years of the program. Given political and economic uncertainties for the foreseeable future, prospects for incentive payments in the later years are still tenuous at best.
The final rules for 2011-2012 clearly note that reimbursement incentives will be “all or nothing” under the program. The law does not allow partial credit. The rules further amplify the exceedingly complex structure of the underlying legislation. (I intended to read all 864 pages before writing this blog post, but I could not get past page 100.) I read the entire ARRA/HITECH law twice last year and did not fully comprehend its ambiguities until trying to digest the final regulations over the past week. I will ultimately get through the final regulations, but I do not expect to experience a “Eureka” moment of enlightenment in the process. The quest for HITECH funds may be easier than expected to start, but I fear it will be harder to complete because answers to the most important questions have been deferred. Yet-to-be specified details are devilish at best.
Nothing that I’ve read over the past week changes my fundamental belief that the need for EHRs is more important than ever. (See last week’s blog post for elaboration of this perspective.) Providers aspiring to be in business beyond 2012 must be engaged in digital transformation now. I don’t think that existing approach to medical records can produce efficiencies demanded by the new medical marketplace. What do you think? Now that we know final rules for the next two years, are HITECH incentives worth pursuing under any circumstances?
1 comments:
Hello Jeff -
It was such a pleasure to meet you at the IAOP even in San Francisco last week. Such interesting things to talk about in this community!
Thought I'd toss a few thoughts out on this subject.
As a consumer and someone who thinks that health and its care is a right not a privilege, I lean towards requirements that ensure that much of what I (and my employer) pay in premiums goes towards paying for the delivery of care for those who access service.
But as a provider, I know how cumbersome (and sometimes ridiculous) the administration of that service delivery is.
For instance: as a Medicare provider, ONLY direct patient care is billable. Yet, much of what I do by way of consultation and training is essential for that care to actually accomplish its objective. Not billable. Medicare sets rigorous documentation requirements in order to ensure claims are paid. Not billable. An employer, however, is looking at a clinician and wants them to spend as much time in billable activity as possible. So CMS sets expectations for activity that is essential to the success of the billed service but creates guidelines that render that activity non-billable.
I think one of the challenges is a population that is unsophisticated regarding the amount of "administrative" activity is essential for clinical delivery to run smoothly. Guidelines such as these sound good on paper, but will result in rushed or ineffective system that create duplication, error and dissatisfaction.
I wish I were wise enough to throw the perfect answer into the ring, but all I can legitimately offer is some modest insight into process.
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