Health-Care Group Calls for IT, Fraud Law Changes This Year

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By Sara Hansard

Feb. 17 — Accelerated progress toward a nationwide health information system, Food and Drug Administration reforms and changes to fraud and abuse laws were among the actions called for Feb. 17 by health industry and patient advocacy groups.

The Healthcare Leadership Council (HLC), which includes providers, insurers, drug and device manufacturers as well as patient groups, said a firm date of Dec. 31, 2018, should be set to achieve health information interoperability with the private sector leading efforts to enable health-care organizations to share data with one another. The group held a briefing on Capitol Hill to announce its recommendations, which it said in a release should win bipartisan support “and can gain traction even in an election year permeated with partisan politics.”

The group also called for implementation by Medicare, insurers and health-care providers of best practices to improve care for chronically ill patients, as well as standardization of national privacy laws and improved access to patient data for medical research.

The recommendations bring together sectors of health care that often are at odds with each other to push for changes the individual groups support. Even with the fierce partisan atmosphere in Washington, bipartisan agreements are possible, such as the 2015 agreement between Congress and administration to get rid of the Medicare sustainable growth rate formula used to pay doctors.

Reduce FDA Administrative Burdens

The recommendations included a series of changes to improve the efficacy of the FDA, in part by reducing administrative burdens and bringing treatments and technologies to the market more rapidly.

In addition, the federal government should “reform outdated physician self-referral and anti-kickback statutes, as well as expand Medicare payment waiver policies, to enable better coordination while protecting against fraud and abuse,” the release said.

The group also said the Centers for Medicare & Medicaid Services should improve its Enhanced Medication Therapy Management Model. “Misaligned incentives have prevented the medication therapy management (MTM) program, part of the Medicare Part D prescription drug program, from achieving significant benefits,” the report said.

In September 2015, the CMS announced its intent to form a Part D Enhanced MTM Model to better align prescription drug plan sponsor and government financial interests while creating incentives for robust investment and innovation, and the model should be “optimized,” it said.

“These steps aren't revolutionary but they are transformative,” HLC President Mary Grealy said in a statement. “Innovation is too often put on the back burner when we discuss healthcare policy, but it's critical to elevating health system value, to addressing quality and cost challenges. There are viable, practical, common-sense solutions that can and should be implemented to help make our healthcare system more patient-centered and effective.”

The HLC has begun meeting with congressional leaders about the recommendations and will continue the conversations in the weeks ahead, Grealy said.

The group's report and recommendations were produced in partnership with NORC, an independent public policy research organization at the University of Chicago.

To contact the reporter on this story: Sara Hansard in Washington at

To contact the editor responsible for this story: Janey Cohen at

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