Medicare value-based payment plan said to mesh with ONC interoperability roadmap

The recent announcement that Department of Health and Human Services (HHS) would accelerate Medicare’s shift toward value-based payments fits well with the 10-year interoperability roadmap released two weeks ago by the Office of the National Coordinator for Health IT (ONC), according to a leader of an ONC advisory panel.

By the end of 2016, HHS expects that 30 percent of Medicare fee-for-service reimbursements will be directed to bundled payments, accountable care organizations and other new models, a threshold that will rise to 50 percent two years later.

“That was very enabling for this [interoperability] work,” Heath IT Policy Committee Vice-Chair Paul Tang, MD, MS, said Feb. 10 at a joint meeting of the Health IT Policy Committee and Health IT Standards Committee. “I think 30 percent is past that tipping point where people start behaving differently.”

Tang also heaped praise on ONC for the 166-page roadmap. “This is a tremendous piece of work,” said Tang, who also called the document “a work of art.”

Erica Galvez, MA, ONC’s interoperability and exchange portfolio manager, also addressed the sheer size of the roadmap. “It is a beast of a document. We tried to be as comprehensive as possible,” she said.

Still, according to Galvez, the idea was to simplify the path forward. A new principle for ONC, one that does not appear in the interoperability “vision paper” the office published last June, is a focus on scaleability and universal access, Galvez said.

“Interoperability is already complex. Let’s not make it more complex than it needs to be,” Galvez said.

The paper described a “learning health system” that would be the goal 10 years out. Galvez called this timeline “a bit ambitious,” which really is nothing new in health IT.

(In 2010, Don Detmer, MD, MA, former president and CEO of the American Medical Informatics Association, and chairman of the committee that wrote the authored the Institute of Medicine’s 1991 report, The Computer-Based Patient Record: An Essential Technology for Health Care, recalled that committee members thought it would take a good 20 years for EHRs to become widespread, but they called for it to happen in 10 years to lend a sense of urgency.)

“These are meant as frameworks that are going to help us whether we’re in the private or public sector,” said John Halamka, MD, MS, vice chair of the standards committee.

In terms of interoperability governance, other committee members expressed concern about “getting too deep into the standards” and stifling innovation. “Set the floor, don’t set the ceiling,” the joint panel was advised.

One comment from the audience asked to make interoperability accessible to “non-techies.”