Meaningful use is dead (long live meaningful use)

MEANINGFUL USE IS DEAD (LONG LIVE MEANINGFUL USE): Say goodbye to meaningful use; per CMS’s diktat in Tuesday’s new inpatient payment rule, we will now refer to the “Promoting Interoperability” program when speaking of the government’s effort to promote electronic health records. Of course, the agency isn’t just putting chrome and fins on the old jalopy — we’ve got a new chassis and engine, as well:

— New scoring: There’s a whole new scoring system to familiarize yourself with. As we know, the old meaningful use program was a thumbs-up or thumbs-down system. The new one is slightly subtler, rating respondents on a 100-point scale. Scores over 50 will evade Medicare payment adjustments, and the scoring is based on the system’s specific metrics. Those were also adjusted. How? Glad you asked.

— New metrics: CMS breaks down the metrics into four categories: e-prescriptions; public health data reporting; health information exchange; and patient data access. Most of the old measurements you’re familiar with from previous iterations of the meaningful use Promoting Interoperability program are still there, in some form … except for the quite controversial patient data access (e.g. view, download, and transmit) stuff.

Meanwhile, the guts of old metrics are changed. Providers will be required to report to fewer registries, though they’ll now have to report to syndromic surveillance programs. And the interoperability requirements will be shifted; in response to all those old complaints about getting the entire CCDA, CMS is now encouraging providers to send a referral note.

There are some new requirements, related to opioids, to consider. Most prominent is a requirement to integrate prescription drug monitoring programs into electronic health records. That will most likely please users, who always hated the lag time to switch from an EHR to a PDMP. But it’ll probably cost some money.

Depending on your performance on various measures here, you’ll get a score. Add it all up, and you’ll see whether you exceed the 50-point barrier.

— Also required: CMS is sticking with the 2019 requirement to transition to the 2015 edition EHRs.

— What they’re saying: Your correspondent’s inbox is starting to chirp with riled-up reactions. The American Hospital Association took a wide-ranging view of the new rule, which of course has lots and lots of non-meaningful use Promoting Interoperability sections. Their overall view is positive; their view of the Promoting Interoperability section is mixed. They’re happy with the new scoring system, disappointed with the shift to 2015 edition EHRs.

CHIME’s board of trustees chair, Cletis Earle, warns that they’re still digesting the rule – but like the removal of the “pass/fail” policy specifically.

eHealth tweet of the day: “ John Moore @john_chilmark
… many, including most lg providers orgs contributed to the problem we have today. It is a cop-out to lay blame solely on EHR vendors.”

[in reply] Dave Chase @chasedave “Afraid our doctor friend has diagnosed the symptom & not the underlying cause. EHR vendors wouldn’t be in business if they weren’t doing the bidding of their clients -- in particular, health systems. My POV is from having spent years insides dozens of health systems w/ hc execs”

WEDNESDAY: Over the weekend, I spent some time thinking of the passing of my colleague on the Health team, Brett Norman, which you read about in Monday’s Morning eHealth. I don’t have anything terribly eloquent to add, but I can offer some news for those who are interested: there is a memorial service, open to all on Saturday at 11 a.m., at All Souls Church on 1500 Harvard St., NW in Washington. And if you have any thoughts about Brett or anything else to share, email at [email protected]. Discuss eHealth stuff 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, 2018. Sign up to keep up with your daily conference coverage.

I’M SORRY MR. JACKSON, THIS TROUBLE IS REAL: Ronny Jackson, a Navy doctor and personal physician to three presidents, appears to be facing long odds winning Senate confirmation to head the Department of Veterans Affairs.

At a press conference with his French counterpart, Emmanuel Macron, President Donald Trump repeatedly appeared to suggest Jackson ought to withdraw his name from consideration, citing the number and viciousness of attacks on his character.

Senators from both sides of the aisle have offered mostly broad concerns about incidents in Jackson’s past that might, or might not, disqualify him from leading the department. On Tuesday, the Senate Veteran Affairs Committee’s ranking member, Jon Tester, got more specific, saying that there were allegations of improper dispensing of drugs and a toxic work environment in the White House physician’s office. If true, they would add to critiques that Jackson lacks experience to lead a sprawling organization. Our colleagues from across Politico have the latest on Jackson’s nomination here and here; the White House appears to believe Jackson’s been framed … by someone inside the administration. The confirmation hearing, originally scheduled for today, has been delayed. It remains to be seen when the hearing will be rescheduled — and whether Jackson will be sitting at the table for it.

— Meanwhile: The House Military Construction and VA appropriations subcommittee is due to release its fiscal 2019 spending plan this morning, with a markup Thursday that presumably will include spending on MHS Genesis and on the VA’s Cerner plans.

OPIOIDS BILLS ADVANCE: Both chambers of Congress remain busy trying to advance opioids-related work:

— House: Doris Matsui (D-Calif.) has introduced two telemedicine bills for inclusion in the big Energy and Commerce opioid bill markup Wednesday. The first, called the “Improving Access to Remote Behavioral Health Treatment Act,” sponsored with Congressman Gregg Harper (R-Miss.), increases access to medication-assisted treatment in underserved communities through telemedicine.

The second, the “Access to Telehealth Services for Opioid Use Disorders Act,” co-sponsored by Tony Cárdenas (D-Calif.), based on an earlier bill (H.R. 3482), would allow HHS to waive Medicare restrictions on reimbursement for telemedicine services provided to patients suffering from an opioid use disorder.

— Senate HELP: Tuesday, the Senate HELP committee approved a wide-ranging bipartisan bill aimed at fighting the opioid abuse crisis.

The Opioid Crisis Response Act, crafted by 38 senators, includes provisions that would promote the use of telemedicine in substance abuse treatment. One of the 40 measures HELP approved as part of that bill directs the attorney general, in consultation with the HHS secretary, to issue rules allowing for special registration for telemedicine providers who prescribe opioids used in medical treatment of drug abuse.

Another provision would require state or local governments to create plans for sharing data from prescription drug monitoring programs within or among states. Yet another would direct the HHS secretary to send out guidance every year informing providers what kind of information they can share with relatives about opioid-related emergencies, including overdoses. The committee still plans to consider additional measures before presenting it to the full Senate, committee Chairman Lamar Alexander said during committee meeting.

Nevertheless, outside groups praised HELP’s work. The Association for Behavioral Health and Wellness, a trade group representing payors, praised the committee’s prescription drug monitoring program work and hoped that the committee passed bills easing 42 CFR Part 2 requirements in the future.

Shatterproof, an organization advocating for families and patients struggling with addiction, praised the bill — but hoped for more requirements for PDMPs.

WHAT THE SMART CLASS IS SAYING: A survey from venture capitalists at Venrock of 300 respondents from various parts of the health care sector — startups, government, investors, and so on — found general optimism for health startups and the tech part of the field. Sixty eight percent expect the number of health care IT companies to grow this year.

But the respondents are skeptical about some of the more buzzed-about events we’ve discussed in this newsletter: 48 percent say the Amazon-Berkshire-JP Morgan hydra will have to be in it for the long haul to succeed, while 25 percent say “they have no idea what they’re getting into.” (Only 16 percent said it was the most important health care event of the past year.)

Other hyped events, the respondents cautioned, will take some time: 54 percent say artificial intelligence will take two to three years to really matter in health care. You can take a look at the full set of questions and responses here.

HOW’D DIRECT TO CONSUMER TELEMEDICINE WORK DURING THE HURRICANES: A new paper — a collaboration between researchers from RAND and elsewhere — took a peek at data from telemedicine startup Doctor on Demand to see how patients used its service during Hurricanes Harvey and Irma last year. As it turns out, the study in the Journal of General Internal Medicine shows, the services provided were mostly for routine care rather than chronic or new issues caused by the disasters.

WHAT WE’RE CLICKING ON:

Some more tidbits from the Amazon-Berkshire Hathway-JPMorgan health care hydra from Axios

A discussion of how to ensure smooth data exchange during a national disaster from a pair of government officials in an Allscripts podcast.

The Atlantic discusses 23andMe’s plans to get data from African, Middle Eastern, and Asian people.