Shulkin under pressure

With help from Darius Tahir and Mohana Ravindranath

MORE SHOALS FOR SHULKIN? New media reports say senior White House officials are losing confidence in VA Secretary David Shulkin, who will be meeting with Chief of Staff John Kelly today. Axios, quoting unnamed officials (who could be some of the same folks who’ve been trying to get rid of him), says the White House has been particularly angered by Shulkin’s comments to me that he had its blessing to purge “subversion” at the agency. A senior White House official said Shulkin had been blocked from firing Trump VA appointees John Ullyot and Curt Cashour. According to other recent accounts, Ullyot last month urged the White House to sack his boss.

— The Daily Beast, meanwhile, reported Friday that Shulkin is the subject of another damaging investigation that could drop as early as this week – it reportedly criticizes his use of his security detail to run personal errands. Shulkin tells POLITICO he’s unaware of any other investigation…. Dropping dimes to the IG is a timeworn tool of political combat at the VA.

— Shulkin seems to still enjoy the support of the House and Senate veterans affairs leadership, but one committee member, Rep. Mike Coffman, is doubling down on his demands that Shulkin go. Coffman, who has beefed for years about an over-budget VA hospital project in Aurora, Colorado, urged Trump to fire Shulkin in a tweeted letter last week.

CERNER TOUTING MHS GENESIS: Just in time for HIMSS, Cerner and Leidos have given some interviews touting the accomplishments of the MHS Genesis rollout in the Pacific Northwest.

— We also spoke to the Cerner/Leidos team and will be presenting a more in-depth assessment … soon. For now, we can report that Cerner General Manager Travis Dalton says the new system is ahead of most commercial builds in the percentage of computer-processed order entry, and also reported “positive metrics” on system-issued alerts that have led to meaningful changes in treatment. Among other things, Cerner created an algorithm in MHS Genesis that warns clinicians when a patient is at risk of suicide — it has fired for 100 patients so far, he said.

— The DoD’s project director, Stacy Cummings, tells us that the Leidos partnership agreed in December to a “stabilization” period at the four bases because of mounting complaints from clinicians. The program, which involves several dozen visiting military and civilian IT experts, will go through March — a bit longer than we’d previously been told — with some team members remaining at Madigan Army Medical Center into April. The intensive sessions with clinicians during the stabilization period will “reduce time in the record and allow more time with the patients,” she said. At the same time, the Defense Health Administration is putting a management structure in place to oversee the medical facilities, previously the responsibility of the services’ surgeon-generals.

— If everything goes according to schedule, Cummings said, she’ll announce success in the initial phase this summer, with the next go-lives in 2019 during a wave of rollouts along the West Coast from San Diego to Alaska.

— As for the VA contract, which Shulkin has put on hold while seeking more commitments from Cerner, Dalton said there were “no particular sticking points prohibiting us from closing the contract.” Cerner will lead that contract, with subcontractors including Leidos, Accenture, Henry Schein and PWC, he said.

Tweets of the DayAisling McDonough @AislingMcDL Just got billed for my own health records.

Sherry Reynolds @Cascadia @himss Is there a trick to using the search function in #himss18 mobile app? You can’t enter anything in search and it locks the screen

Welcome to Monday morning eHealth, from your Health IT Cassandra-in-Chief. By the way, how many of the 40,000 HIMSS-goers will have a wearable that measures blood alcohol limits? Or genetic risks for gambling addiction? Approach us with tips on the exhibition floor or send policy news to [email protected] and [email protected], who will be in Vegas by tomorrow morning. Alternatively, tweet @ravindranize, @athurallen202, @DariusTahir, @POLITICOPro, @Morning_eHealth.


MORE ON INTEROPERABILITY: We reported Friday on a KLAS report critical of the interoperability work of the CommonWell Health Alliance, but got a slightly different take in a conversation with Evan Grossman, a vice president at athenahealth, the only major EHR vendor that freely hooks its clinicians up to CommonWell and Carequality. Because Epic connects all its clients to Carequality, athena does most of its exchange there. Fewer than a third of the clients of Cerner — CommonWell’s biggest vendor — are hooked up to that network, which makes it less useful. But Grossman notes that athena has to build and test endpoints each time a care site goes live on Carequality, while new sites are automatically visible on CommonWell, without testing.

— Of course exchanging data is just the start. Making information useful, for example by assuring doctors notes are in the right place in consolidated care documents, is another enormous challenge.

FUNDING FOR NEW QUALITY MEASURES: CMS has announced a $30 million funding opportunity for cooperative agreements to help the agency develop new measures for the quality payment program under MACRA. In a blogpost on Friday, Chief Medical Officer Kate Goodrich called out to specialty societies, professional organizations, patient advocates, health systems and researchers to work on issues like clinician engagement, burden reduction, consumer-informed decisions, quality measure alignment and efficient data collection. CMS hopes to create measures that are more in tune with clinical and patient perspectives.

— The agency has also created a new frequently asked questions page for EHR incentive programs.

ANTHEM, AMA COLLABORATE ON VALUE INITIATIVES — Anthem and the American Medical Association announced a partnership to bring down medical costs and improve outcomes. They intend to collaborate on improving health care literacy, reducing prior-authorization requirements and developing value-based payment models.

CHIMING IN: The College of Health Information Management Executives has suggested that CMS allow cybersecurity improvements and opioid data enhancements to be improvement activities in MIPS. In a letter to CMS Administrator Seema Verma last week, CHIME’s leadership said meeting at least 75 percent of the best practices developed through the Cybersecurity Information Sharing Act of 2015 could be an improvement activity. CMS should also give credit to clinicians for using more electronic prescribing of controlled substances or employing clinical decision support to implement the CDC’s guidelines for opioid prescribing. “Some EHR vendors are beginning to build these guidelines into their CDS products and we believe clinicians should be encouraged to use them,” the group said.

OTHER OPIOID NEWS: Opioid prescriptions fell 20 percent in Wisconsin over the past three years, according to a report by the state’s Controlled Substances Board. Pharmacies dispensed about 4.1 million opioid prescriptions in 2017, down from 5.1 million in 2015, according to the report Friday. Many states around the country have seen a decline in opioid prescriptions in recent years—but not a decline in opioid deaths, as heroin and fentanyl fatalities have rocketed upwards. More details here.

ICYMI: Two bills introduced in the Senate last week feature new requirements for prescription drug monitoring programs and e-prescribing. The Every Prescription Conveyed Securely Act ( H.R. 3528 (115)), sponsored by Sens. Michael Bennet, Elizabeth Warren, Dean Heller and Pat Toomey, would mandate electronic prescribing for controlled substances be reimbursed by Medicare beginning in 2020. The Comprehensive Addiction and Recovery Act (CARA 2.0), introduced by a bipartisan group led by Sen. Rob Portman, mandates the use of PDMPs across the country within one year.

WHAT WE’RE CLICKING ON:

— Health Affairs: Physicians’ vision for CMMI.

— Milwaukee Journal Sentinel: Integration of four EHR systems contributes to chaos at Wisconsin’s second-largest health care system

— Healthcare IT News: Zane Burke on Cerner’s Apple collaboration

— Health Tech Magazine: Tom Leary critiques White House proposed health IT budget