Health Datapalooza day one preview

With help from Arthur Allen ( @arthurallen202 ) and Mohana Ravindranath ( @ravindranize )

HEATH DATAPALOOZA DAY ONE PREVIEW: The first day of the now-venerable Health Datapalooza conference is kicking off at the Washington Hilton. The eHealth crew will be on the ground in force — your correspondent and his colleague, Mohana Ravindranath, will be there. Here’s what we’re looking forward to:

— Some bold-letter names: The conference is stacked with important government officials: just as a quick pass we note HHS Deputy Secretary Eric Hargan as well as department CTO Bruce Greenstein; FDA commissioner Scott Gottlieb; CMS Aministrator Seema Verma; ONC’s Genevieve Morris, and many more. While CMS has recently announced a big policy change, we’ll keep an ear bent to the other agencies who might have some interesting plans to splash at the conference.

— PULSE CHECK on the ’palooza: Lisa Simpson, whose AcademyHealth organized the datapalooza, joined POLITICO’s Dan Diamond on the PULSE Check podcast Wednesday to discuss how the Obama administration passed the health data baton to Trump’s.

“In any administration, we are always pushing for more data release and more transparency,” Simpson said on the podcast. “The latest example of concern that was raised was around the Medicare Advantage data,” she said, referencing a JAMA article co-authored by former CMS Chief Data Officer Niall Brennan that criticized the Trump administration for abruptly canceling a scheduled data release. Pros can read Dan’s story on their conversation here, and listen to the podcast here.

DEBATE ON CONDITIONS OF PARTICIPATION ERUPTS: Everyone’s talking about CMS’s musing that the agency might require some baseline interoperability from hospital participants in the Medicare program. In theory — and keep in mind that since CMS is soliciting comments, it’s just a theory at this point — it’s a big stick with a big goal. In practice, while there’s some giddiness over the idea, we also heard some reluctance from various interested parties.

— Happy!: Former ONC head — and current CEO of Aledade, a startup that helps independent practices with ACOs — Farzad Mostashari was extremely pleased. Mostashari unleashed a long twitter thread giving the historical backstory leading to the concept, concluding that hospitals will always find one reason or another to avoid sharing data absent a strong policy lever. “It is time,” he concluded. “As @SecAzar said, ‘it will require some degree of federal intervention — perhaps even an uncomfortable degree. That may sound surprising coming from an administration that deeply believes in the power of markets and competition.’”

— Wary: Other people we contacted emphasized their wariness, while often hedging by saying they hadn’t yet read and understood the full document.

“My only worry is that people may mistakenly think the technical part of interoperability is done, and it isn’t,” Stan Huff, the CMIO of Intermountain Healthcare, said. “Hard work still needs to be done to make truly interoperable exchange possible. It will be a truly unfortunate outcome if interoperability is mandated through conditions of participation and ‘interoperability’ is not sufficiently defined so that it can be consistently and uniformly implemented by all parties.”

“My gut reaction is this is premature,” said Mari Savickis, vice president of federal affairs at CHIME. “[We] need to give some other pieces of the interoperability puzzle some time to work out before we begin talking about changes,” she concluded, arguing that hospitals and vendors had a lot of items to check off their list — such as ONC’s new 21st Century Cures rules, the meaningful use overhaul, and so on — and that adding another big item would overstress them.

— Yeah, but will it happen?: Of course, many’s the big idea in Washington that gets scuttled by practical realities. This is, by CMS’s own description, just a request for information. So how likely is it to be enacted in some form? Jeff Smith, the American Medical Informatics Association’s vice president of public policy, admitted he didn’t know how to handicap the idea’s chances: “I have no earthly idea,” he said, when asked about its odds.

eHealth tweets of the day: Arien Malec @amalec

1/ Everyone hates CQMs but very very few propose workable alternatives that aren’t more intrusive.

2/ CQMs are imperfect approach to notion that to use markets to improve #HealthCare you need to purchase on value

3/ alternates are current quantity-based purchasing with non-value-sensitive rationing (through defined contribution or high deductibles) OR

4/ global budgets, price control (all payer rate setting), etc.
CQMs + VBP is a sort of mushy policy middle

THURSDAY: Apparently Wednesday was DNA Day; one wonderful tweet shared this (slightly NSFW) classic cartoon from xkcd, which we will link to here. Feel free to share your favorite xkcd cartoons at [email protected]. Discuss cartoons on social media at @ravindranize, @athurallen202, @DariusTahir, @POLITICOPro, @Morning_eHealth.

POLITICO’s Ben White is bringing Morning Money to the Milken Institute Global Conference to provide coverage of the day’s events and evening happenings. The newsletter will run April 29 - May 2. Sign up to keep up with your daily conference coverage.

JACKSON WITHDRAWS AS VA NOMINEE: Rear Adm. Ronny Jackson has withdrawn his nomination to lead the Department of Veterans Affairs amid damaging allegations that he created a toxic work environment, drunkenly wrecked a car and maintained poor prescription records while serving in the federal government.

“While I will forever be grateful for the trust and confidence President Trump has placed in me by giving me this opportunity, I am regretfully withdrawing my nomination to be Secretary for the Department of Veterans Affairs,” Jackson said in a statement on Thursday morning.

He added, “The allegations against me are completely false and fabricated. If they had any merit, I would not have been selected, promoted and entrusted to serve in such a sensitive and important role as physician to three presidents over the past 12 years.” Full story.

— VA details short-term plans: The department is still rumbling along even with the gaps at the top. The VA’s spokesman Curt Cashour said in a release Wednesday that VA acting secretary Robert Wilkie’s goal is to finalize that EHR contract, among other matters. Cashour also noted the departure of CIO Scott Blackburn and principal deputy undersecretary for health Christopher Vojta.

— House appropriators release fiscal year 2019 Veterans Affairs legislation: The House Appropriations Committee on Wednesday released its fiscal year 2019 legislation dealing with the Department of Veterans Affairs. The bill has $1.2 billion for the long-awaited new EHR system.

WHAT ABOUT THE PRICE TRANSPARENCY PARTS OF THE MEDICARE RULE?: One other important development in Tuesday’s Medicare rule: requiring hospitals to post machine-readable prices online, available to be gulped down by citizens and their computers alike. But there are legal barriers blocking that information from being posted in meaningful format, writes our colleague David Pittman.

Hospitals have two kinds of prices: their chargemaster prices, which few patients actually pay; and the prices that insurers and others negotiate. The former isn’t useful, and the latter is proprietary, meaning it’s difficult to force hospitals to disgorge, former ONC director (and current Commonwealth Fund president) David Blumenthal said.

“I don’t know what legal authority they have through Medicare that isn’t available to states to force the release of actual prices paid,” said Blumenthal. “This has to be seen as a very preliminary first step.”

Hospital groups sound like they’d like more details. Pros can get David’s story here.

HOUSE E&C SUBCOMMITTEE ADVANCES OPIOID HEALTH IT BILLS: The House Energy and Commerce Health subcommittee voted Wednesday to approve 56 measures crafted to fight the opioid crisis, including some related to telemedicine and EHRs.

Despite the work stretching late into the night Wednesday, several items were left unaddressed, and subcommittee chairman Michael Burgess said many of them required further consideration before being discussed in the full committee markup, which he expected to be scheduled after some weeks. (Democrats were a bit peeved by this, as they believed many of their items never got brought up; a committee aide said their bills will still get good-faith consideration.)

Some of the bills dealt focused on EHRs — what information they contained, and how they could convey prescription orders. They included H. R. 3331, which would amend the Social Security Act to encourage testing incentive payments that might get behavioral health providers to adopt and use EHRs. Another bill, the Every Prescription Conveyed Securely Act, H.R. 3528 (115), would require Medicare Part D to cover e-prescription of controlled substances. Finally, Jessie’s Law would clarify when a patient’s history of opioid abuse would show up in their health records.

Three telemedicine measures were approved: first, the Use of Telehealth to Treat Opioid Use Disorder bill would give the HHS secretary the authority to waive Medicare telehealth requirements for the treatment of opioid abuse; the Special Registration for Telemedicine Clarification Act of 2018, H.R. 5483 (115), would specify when certain providers can register to practice telemedicine; and, finally, the Improving Access to Remote Behavioral Health Treatment Act of 2018 would allow community health centers to facilitate telemedicine consultations.

Among the bills that weren’t considered were former Rep. Tim Murphy and Rep. Markwayne Mullin’s “ Overdose Prevention and Patient Safety Act,” H.R. 3545 (115), which would make it easier for providers to access information about patients’ substance abuse history.

REPORT REVIEWS CMMI’S WORK: CMS wants six Innovation Center models to lower costs and hit quality improvement marks this year, a GAO report released Wednesday reveals. As it turned out, four CMMI models met those goals in 2016. And, of the 37 demos and projects the center has test-driven since its creation, just two have been expanded. (One of those, the diabetes prevention program, is of high interest to startups like Omada Health. On the other hand, telehealth groups have been frustrated by what they perceive as CMMI’s slow pace in implementing payment schemes.)

The report, requested by Republicans on the Senate Finance and House Energy and Commerce Committees, also notes that CMMI spent $5.6 billion of its $10 billion tranche of money as of September 2016. The center is set to receive another $10 million in October.

WHAT WE’RE CLICKING ON:

The Association of American Medical Colleges discusses med schools’ efforts to teach students how to practice telemedicine.

An app that tells you the smokes-per-day equivalent of all the urban pollution you’ve been breathing in.

Doctor on Demand raises $74 million in new funding.