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By James Swann
Dec. 8 — Health information technology is expected to remain a priority in the Trump administration, but government mandates may be scaled back, industry stakeholders told Bloomberg BNA.
A government-led approach to health IT implementation has been a hallmark of the past eight years, ranging from the electronic health records meaningful use program to requirements for electronic prescriptions, but some physicians have opposed the initiatives, arguing they're costly and administratively burdensome.
The incoming Trump administration may prefer a private-sector led approach to health IT implementation, reducing the direct role of the government, Stephanie Zaremba, director of government and regulatory affairs at athenahealth, told Bloomberg BNA.
“We’ve seen government propping up HIT implementation, and if that dynamic changes in a Trump administration, that may not be a bad thing,” Zaremba said. athenahealth is an EHR developer based in Watertown, Mass..
Zaremba said she wouldn’t be surprised if Rep. Tom Price (R-Ga.), the prospective nominee for the top position at the Department of Health and Human Services, is open to pulling back from government health IT mandates because he had experience as a physician dealing with the mandates. athenahealth has had a good working relationship with Price for many years, she said, adding that he brings experience as both a policy maker and a physician.
The meaningful use incentive program is the likeliest government initiative to be scaled back or otherwise changed, Zaremba said.
Under the meaningful use program, hospitals and physicians are required to certify they’re using EHRs to accomplish a range of tasks or face Medicare payment cuts. While the Merit-Based Incentive Payment System, scheduled to begin in 2017, will replace meaningful use for physicians, it’s still in place for hospitals.
Physicians have complained about the burdens imposed by the meaningful use program since it was it implemented, and Price has worked in Congress to reduce those burdens, Colin Zick, an attorney with Foley Hoag LLP in Boston, told Bloomberg BNA.
For example, Price introduced a bill in 2015 (H.R. 3940) that would have provided a hardship exemption from the meaningful use program, Zick said.
“Now physicians will have one of their own as HHS secretary,” Zick said.
Physician complaints against the government’s approach to meaningful use were bound to lead to a pushback on the regulations, regardless who won the election, Zick said, noting it still costs too much for a physician to install an EHR system.
“The revolt has already started,” Zick said.
Zick said EHRs are still too complicated and haven’t delivered a simple, seamless way to collect and transmit medical records.
“It’s still as horrible to go through an EHR implementation today as it was 20 years ago,” Zick said.
The Office of the National Coordinator for Health Information Technology (ONC) is likely to take on a different form, at the very least, under a Price-led HHS, Zick said.
“It’s important to remember that HIT is supposed to be a means to an end for bending the cost curve, and there has to be more emphasis on that,” Zick said.
Reducing physician burdens is likely to be a key theme for Price, Tom Leary, vice president of government relations at the Healthcare Information and Management Systems Society, told Bloomberg BNA.
Price has consistently supported easing provider burdens, and wants the technology to move forward and help reduce burdens, Leary said.
“Price has challenged us to improve interoperability, and I expect that will be a big priority for him,” Leary said.
Leary said it remains to be seen whether Price will leverage any of the changes made by the Medicare Access and CHIP Reauthorization Act (MACRA) or take a look at the ONC’s work certifying EHRs.
However, Leary said he didn’t anticipate any dramatic changes to the ONC, at least not in the short term.
Health information technology and the idea of electronic interoperability have enjoyed bipartisan support for the last several years, but the incoming administration might be pressured to reduce ONC funding if it needs to reallocate resources to pay for its more sweeping goals relating to health care, Eric Fader, an attorney with Day Pitney LLP in New York, told Bloomberg BNA.
Fader said the new administration is likely to favor programs that can be cash positive, or at least cash neutral.
Rep. Price generally supports deregulation, which suggests that certain initiatives like the ONC’s certification program for EHRs could be made less prescriptive, Fader said.
“As a physician, he is expected to particularly favor measures that will reduce the overall regulatory burden on clinicians, but on the other hand he undoubtedly recognizes that the transition to value-based reimbursement is necessary to reduce costs to the health-care system overall and will require universal use of EHRs,” Fader said.
The general short-term uncertainty associated with the incoming administration may discourage some health-care organizations from committing to new HIT investments for a while, at least until the future of the Affordable Care Act is resolved, Fader said.
However, this effect may be muted because some programs that encourage advances in HIT, like the Quality Payment Program under MACRA, should continue undisturbed at least through 2017, Fader said.
“I don’t think any lawmakers will want to mess with the MACRA regulations because MACRA replaced the universally loathed SGR [sustainable growth rate], and some initiatives like meaningful use are probably too far along to be undone and don’t trigger the visceral reactions that the ACA does,” Fader said.
Price’s experience as a practicing orthopedic surgeon means he’s familiar with the effect health IT regulations can have on patients and access to care, Meg Marshall, senior director of public policy at Cerner, a publicly traded health-care technology company, told Bloomberg BNA.
Marshall said Price has spearheaded efforts to ensure that regulations encourage patient access, choice and quality, without overly or unnecessarily burdening providers, including his involvement in the oversight of the EHR meaningful use incentive program and MACRA.
“We look forward to working with the new government, including Price, as it reflects upon lessons learned to sharpen its focus on advancing the nation’s health-care system and protecting the role of health IT as fundamental to achieving high quality, low-cost care for Americans,” Marshall said.
Beyond easing the health IT burden for providers, HIMSS’s Leary said he anticipated the incoming administration would focus on health-care cybersecurity.
Leary said he hoped Price would focus on using the National Institute for Standards and Technology cybersecurity framework for the health-care system, as well as formalizing the role of the HHS chief information security officer.
The new administration should also work to increase the number of cybersecurity professionals, Leary said.
Leary said the new leadership team at the HHS should take a look at expanding reimbursements for telehealth beyond its current very narrow definition.
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