HIMSS talks HIT components of SGR legislation

The Health Information Management and Systems Society (HIMSS) is just one of many stakeholders pleased with the recent House vote to eliminate the sustainable growth rate (SGR) formula that for years has threatened to cut physician payment from Medicare. The group is especially happy about the focus on both interoperability and alignment of quality reporting, said Tom Leary, HIMSS vice president of government relations in an interview with Clinical Innovation + Technology.

The alignment of quality reporting initiatives has been an organizational focus for HIMSS for some with it being one of the group’s “Congressional asks” last fall during National Health IT Week. And, not just from a Centers for Medicare & Medicaid Services’ (CMS) perspective, Leary said, but as they’re developing new legislation they should emphasize” alignment. That way, “we all win because then CMS isn’t creating a one-off program as a result of legislative mandates that is stuck out to the side while others start to align.”

With Meaningful Use coming to an end with Stage 3, further updates will be incorporated into this physician payment and inpatient prospective payment system regulations that providers already pay close attention to. Providers will have fewer regulations to track to be compliant, he said. “Further alignment is going to do wonders to reduce confusion for providers and hospitals.”

Regarding interoperability, Leary said there has been notable progress over the years. Integrating the Healthcare Enterprise (IHE) was established in 1998 with just a few organizations involved. There are now well over 100 organizations and 15 different profiles in use. Common interpretation increases the likelihood that data are going from point A to point B and those data are usable, he said.

“Where we’re still not finished is leveraging the interoperability roadmap and the public-private efforts that are underway. Those are all starting to really work closely together, reducing the overlap. Ultimately, we’re looking for information exchange that supports care coordination which is exactly what the Affordable Care Act anticipated.”

While some other professional advocacy groups have expressed disappointment that the SGR bill sits in limbo during a two-week Senate break, Leary said the delay doesn’t mean much from a health IT perspective. “I don’t think there will be a long-term impact on how Congress envisions health IT supporting quality reporting and more value-based purchasing of healthcare.”

Leary also wanted providers to understand that they will not automatically have to adjudicate electronic claims submissions as of April 1. CMS is required to allow two weeks between electronic submission of claims for payment and adjudication so “providers are still going to have an opportunity to reimburse at the higher level. There is an ability to press pause until Congress finalizes its actions on the SGR appeal.”

Looking ahead, Leary said HIMSS will pay close attention to dates identified for achieving some level of interoperability and how those “marry up with the future legislation around interoperability we’re expecting out of House and Senate later this summer.”