Mostashari to Senate: No pause needed for MU program

In the first of a series of Senate Finance Committee hearings planned on health IT, witnesses Farzad Mostashari, MD, ScM, national coordinator for health IT and Patrick Conway, chief medical officer and director, Center for Clinical Standards and Quality and acting director, Center for Medicare and Medicaid Innovation, reported on progress of the Meaningful Use (MU) program and advised against temporarily halting it.

The hearing came three months after six Republican senators—Sens. Alexander Lamar (Tenn.), John Thune (S.D.), Pat Roberts (Kan.), Richard Burr (N.C.), Tom Coburn (Okla.) and Michael Enzi (Wyo.)—released a white paper calling for a pause of the program to address interoperability concerns and re-examine current procedures put in place to safeguard and ensure meaningful use of EHRs prior to forging ahead with Stages 2 and 3.

“I do not want progress stalled on implementing technology, but if we ignore problems along the way, we’ll end up further behind,” said Sen. Orrin Hatch (R-Utah) at the July 17 hearing. “We can’t afford to invest in systems that don’t work or have to be redone in a year. We have the opportunity to push the pause button.”

Mostashari advised against delaying the program, noting that more than 80 percent of eligible hospitals and 50 percent of eligible professionals have adopted EHRs and received incentive payments—with the use of electronic prescriptions and computerized physician order entry spiking.

“A pause in the program would stall the progress that has been hard fought,” he said, saying that there is sufficient movement for Stage 2 to move ahead. “We need to meet the urgency of the moment for the transformation of healthcare. A pause would take the momentum away from the progress.”

Sen. Max Baucus (D-Mont.) said he hopes for no surprises if providers are unable to keep up with the next stages of MU. “Don’t blindside us with a phone call.”

Rural adoption of EHRs and their unique challenges of compliance were repeatedly brought up by the committee.

Mostashari said nationwide extension programs with “boots on the ground” are working directly with critical access hospitals and small providers to overcome adoption barriers. He addressed some of the barriers, in particular IT staff shortages—remarking that at some hospitals, the person in charge of maintenance is often the same person handling IT matters. The extension programs, he said, are working on these issues by providing regulatory and technical assistance but “we can do more.”

When Sen. Baucus suggested that rural providers need more time for Stage 2, Mostashari answered, “I’d much rather see rural hospitals keep up rather than assume they’ll fall behind.”

Interoperability concerns also came up. Mostashari agreed that it is a “daunting task” to secure health information exchange among providers using disparate systems. However, he said new technical, nonproprietary standards that will come out next year will have a measurable improvement in the ability for organizations to talk to each other.

Sen. Debbie Stabenow (D-Mich.) noted reports of vendors selling products that fail to meet Meaningful Use objectives and do not communicate with other systems. Also, she said some providers are told it would cost more if the systems are interoperable.

Mostashari responded that his agency recently rescinded the certification of two vendors and that a new code of conduct was released by vendors, which includes a promise not to block information.

In response to Sen. Ron Wyden (D-Ore.), who said that providers are having a hard time accessing Medicare and Medicaid data, Mostashari responded, “Providers are now getting more data from Medicare than they ever have had before,” and said the rise of new payment systems through accountable care organizations has driven this effort. “It’s better than it has ever been, I believe.”

Conway added that the agency provides monthly data feeds to ACOs.

In a side topic, Sen. Chuck Grassley (R-Iowa) touted his bill, the Medicare Data Access for Transparency and Accountability Act, which would require a searchable database of provider claims to bolster transparency and curb billing fraud. Mostashari and Conway both expressed support for the legislation, with Conway offering to provide technical assistance.