Measures slashed (and more) in new payment rules

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

MORE MEASURES SLASHED: It’s become a familiar sight from CMS — a new batch of payment rules and some more measures chucked out the door. Tuesday, the agency rolled out final 2019 payment rules for psychiatric facilities, inpatient rehab facilities, and skilled nursing facilities. This time around, the agency is removing two measures from the inpatient rehab rules and five measures from the psychiatric facilities quality reporting programs.

— Also… There’s another curio contained in the rules. When it comes to inpatient rehab facilities, the agency is joining the Skype age. In order to be reimbursed for an inpatient rehab claim, the facility has to document that it came as a result of cooperation between different types of providers. That involves, in part, a weekly check-in meeting between the team caring for the patient. While a physician previously could call into the meeting, the agency is now allowing the physician to videoconference into the meeting. We’re sure other telemedicine providers are eagerly awaiting additional rules advances like this.

SENATE HELP TACKLES ADMINISTRATIVE COSTS: The high cost of jumping through health care’s administrative hoops was criticized at a Senate HELP hearing Tuesday, with the deficiencies of health IT getting particular attention.

Witnesses blamed the high cost of compliance with HIPAA (in the case of the American Action Forum’s Robert Book), quality reporting mandates (in the case of the Alaska State Hospital and Nursing Home Association’s Becky Hultberg), reliance on manual rather than electronic transactions (in the case of AHIP’s Matt Eyles), and the bad computers (in the case of Harvard’s David Cutler).

In the short term, Hultberg probably provided the most relevant point for health IT watchers: She opposes CMS’s idea for imposing interoperability via Medicare’s conditions of participation. “A new mandate tied to [the conditions] is not the right mechanism to advance health information exchange,” she said in her prepared testimony. “CMS should recognize impediments to information sharing and address them directly.”

A more big-picture policy proposal came from Cutler, who proposed that the federal government — including HHS, DOD and the VA, among others — be mandated to adapt IT to reduce health care administrative costs. For example, he said, the documentation associated with pre-authorization ought to be transmitted seamlessly and digitally — instead it’s done by hand.

“Normally, we think of computers as making up for the limitations of people,” he said. “In health care, it is people who make up for the limitations of computers.”

Transcending the current limitations of computers would require investment by doctors, EHR vendors, and insurers, and yet none of these groups have sufficient incentive to get it done. The federal government, he suggested, has both the incentive and leverage to accomplish the goal, and it should be prodded into doing so.

— Meanwhile… Some of the comments at the hearing drove Sen. Bill Cassidy to remark that it was as if he were dropping acid. “Not that I’ve ever dropped acid. But…for the record, I have not.” Video here.

eHealth tweet of the day: Alexander Gaffney @AlecGaffney “Health policy problems: No, Microsoft Word, I really did mean to type HSA the last 50 times I wrote it in this document. No, I didn’t want to type HAS. Yes, i’m sure.”

WEDNESDAY: Your correspondent is sure someone’s written a trend piece on this subject, but there’s been a rapid expansion of independent bookstores across D.C. — it’s pretty crazy to wander around and see yet another branch of Politics and Prose. What accounts for the bookstore explosion? Talk bookstores at [email protected] Discuss bookstores socially at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro, @Morning_eHealth.

GENETIC DTC FIRMS ROLL OUT PRIVACY STANDARDS: A group of genetic direct-to-consumer firms and think tank Future of Privacy Forum rolled out a set of “Best Practices” for privacy Tuesday. The standards come amid mounting public discussion about the best way to collect and analyze participants’ DNA while preserving their privacy.

Recently, controversies have been stirred by law enforcement use of genetic databases to solve long-dormant murder cases, and a data breach admitted by one DTC firm, MyHeritage, in June.

The policy covers a set of best practices for ensuring privacy, including a pledge to release genetic data to law enforcement only following a valid court process.

It states that express patient consent is needed to transfer data to third parties, or to allow marketing to users. Deidentified data, however, “is not subject to the restrictions in this policy, provided that the deidentification measures taken establish strong assurance that the data is not identifiable,” the document states.

ASYNCHRONOUS TELEMEDICINE MAKES A CASE IN WASHINGTON: Trade group HealthITNow convened telemedicine companies on the Hill on Tuesday to plug efforts to speed the deployment of 5G — a technology they say is essential for telemedicine in rural areas. The group recently endorsedthe STREAMLINE Small Cell Deployment Act — introduced by Sens. John Thune and Brian Schatz — which would simplify the approval process for the small cell wireless facilities installed on poles and buildings.

At the briefing, the group’s executive director Joel White emphasized that asynchronous communication especially requires low-latency and high fidelity connections, and potentially 5G, because those platforms are often for more complex cases being directed to specialists.

REBRANDING — GOT A SUGGESTION? The Healthcare Services Platform Consortium, created in 2013, and the newer Clinical Information Interoperability Council, are planning to merge and rename themselves, we learned during their joint meeting Tuesday at NIH. The hope is to draw in more medical societies to bolster the groups’ work on defining data elements in ways that make it easier to share health information.

As it is, even within specific societies there can be multiple terms for the same thing. The American College of Cardiologists, for example, has 24 registries that only infrequently can share data amongst themselves. Why?

“The entropy of the universe,” says Intermountain Healthcare chief medical informatics officer Stan Huff, who also chairs the HSPC board. Around the time of HITECH, clinical specialists agreed it was important to come up with shared data definitions across and within specialties. But “someone dropped the ball,” Huff said. “HL7 thought the clinical societies would create an organization to do it. The societies thought HL7 would do it, and it just fizzled out.”

The goal is to be able to use modeling and SMART-on-FHIR technology to integrate applications across the health care system — for instance, to make the sepsis program used by Intermountain available to a 200-bed rural hospital “as easily as downloading Yelp onto your iPhone.” This is going to take a while though. How long? “Five, ten, 15 years,” says Huff.

EHR VENDOR PAYING THE PRICE: eClinicalWorks paid $132,500 in penalties to HHS’s Office of Inspector General, related to its failure to report patient safety issues in timely fashion. The company had agreed, as part of its settlement with the government last year, to a corporate integrity agreement binding it to report such issues.

FUNDING WATCH: The Senate’s top appropriator, Sen. Richard Shelby, said the upper chamber could call up the Defense plus Labor-HHS-Education spending bills this week. That would put the bills on track to be debated the week of August 13, and help avert any possible government shutdowns. Pros can get the rest of our Budget colleague Jennifer Scholtes’s report here.

DIRECTTRUST GROWTH: Use of Direct messages to transmit health information continues to grow rapidly, DirectTrust announced Tuesday. There were 50.5 million transactions in this year’s second quarter, a 26 percent increase over the same period in 2017. The number of health care organizations and addresses grew by a similar percentage.

NEWT SIGHTING: It seems former Speaker of the House Newt Gingrich paid a visit to HHS, CMMI director Adam Boehler revealed via twitter Tuesday. Flashback to our 2016 article on Gingrich’s long history as a health IT booster.

PERSONNEL NOTES: Some shuffles to keep track of:

— Landmark Health: Boehler’s previous gig at Landmark Health is filled. On Tuesday, the company announced a new CEO, former McKesson executive Nick Loporcaro.

WHAT’S IN A NAME? Telemedicine giant Teladoc will now be known as Teladoc Health, the company announced.

WHAT WE’RE CLICKING ON:

Vox profiles ProjectECHO and its potential to help educate providers about addiction treatment through tele-conferencing.

Integrating Michigan’s PDMP into EHRs has proven to be a difficult task, an article in Crain’s Detroit Business reveals.

A startup profiled in Venture Beat will try to improve clinical trials — it’s starting with an ophthalmology registry.