CMS rep: Health IT will help complexity of care delivery, eventually
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“We realize from the physician, patient and family perspectives that the lack of coordination is not supportive, and it’s unsustainable,” said William J. Kassler, MD, MPH, chief medical officer for the New England region of CMS, during a Sept 6. exposition hosted by the R.I. regional extension center.
From carrot to stick
Government efforts to improve healthcare quality and reduce healthcare costs will increasingly rely on health IT-enabled care coordination.
The recently released Meaningful Use Stage 2 measures will require providers to electronically communicate with each other and their patients to receive payments through the EHR incentive program. The Physician Quality Reporting System currently offers incentives simply for reporting, but physician groups and individual physicians will face Medicare payment penalties beginning in 2015 if they fail to report or fail to meet quality measures.
“It’s a lot of carrot and stick, but it’s mostly perceived as stick and excessive intervention,” Kassler said. “There are a lot of doctors I talk to that would rather all this go away.”
Barriers
Health IT-enabled care coordination is difficult to achieve when current health IT functionalities fail to meet provider needs.
“People are feeling a little dissatisfied,” said Kevin L. Larsen, ONC's medical director of Meaningful Use. “They don’t have what they really want yet. In Stage 2, we’re looking to advance clinical practice. We’ve got a long ways to go before we hit our final goal.”
“EHRs don’t support doctors all that well,” he added. “EHRs, in many ways, are not as sophisticated as they need to be. Medical care is complex and doctors want EHRs to manage that complexity.”
A Meaningful Use Stage 2 measure requiring providers to prove they’ve electronically shared health information with at least 5 percent of their patients has been criticized by the American Hospital Association because EHR and health information exchange functionalities may not allow it. In addition, providers are still relying primarily on claims data to publically report quality improvement activities. This requires paper chart abstraction, an endeavor that demands significant resources.
Using claims data to indicate quality improvement is problematic. As healthcare trends toward pay-for-performance, the goal is to use clinical data to determine payments, according to Larsen. “Ideally, clinical data is the information that informs payment, not claims data.”
It will get better
“Do not despair” seemed to be the message that Kassler and Larsen were trying to communicate, while also reassuring the audience that CMS and ONC are there to help.
“The government has worked hard, and CMS has led the charge, to move the national strategy in one direction,” Larsen said.
As the healthcare provided to patients is fractured, so too are the policies that guide it. However, health reform legislation like the HITECH Act and the Patient Protection and Affordable Care Act are still in their early years of implementation, and collaborative efforts between the federal government, state governments and the private sector are gaining momentum. As these efforts move forward, ONC will work to develop the technological infrastructure for a national system of interconnected healthcare stakeholders, and CMS will work to develop delivery and payment models that work for providers, payers and patients.
The PPACA provide CMS with more power to discover and implement strategies to “support you in what you do,” Kassler noted. “You will select the models that work for you. We will explore how they may work better.”
Larsen pointed to the iPhone as a tool that EHRs and health IT devices should aspire to emulate. “It’s easy to use, but it’s not really simple when you know the technology took a lot of hard work to develop. That’s what we need to aim for. That’s the goal we need to have in mind. We need tools that sophisticated that help care that much.”
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