VA gets its MITRE report

With help from Mohana Ravindranath and Darius Tahir

Will Mick the Knife seek to slash ONC’s budget? Will he take another whack at AHRQ? We’ll find out soon, as the Trump administration’s budget proposal is released around noon today. OMB Director Mick Mulvaney did give us a general picture on Sunday of his plans — boost spending for weapons systems, veterans and the opioid fight, slash most of everything else.

But before we go down the budget rabbit hole, this news regarding our friends at the Veterans Administration:

— A well-placed source tells us that MITRE Corp. has delivered its report on Cerner’s capacity to provide a state-of-the-art interoperability solution to the VA. You’ll recall that VA Secretary David Shulkin asked for the study after deciding in December to put a freeze on the Cerner contract until he could win assurance of its bona fides for efficient and seamless data sharing.

— No word yet on the contents of the report, but we understand it has been shared with congressional Veterans Affairs committees, and the VA is saying it will probably announce the award by early March. In other words — and don’t hold us to this — it doesn’t seem that MITRE is going to be the one to throw a wrench in the works of a contract expected to be worth a minimum of $10 billion over 10 years.

— Bringing in other vendors? Another well-placed source tells us that the interoperability solution might involve other EHR vendors, in the short or longer term. We asked Allscripts CEO Paul Black about this, and he said his company has been meeting with Shulkin and IT specialists at the VA and DoD about that possibility. Allscripts says the interoperability platform it has created at the University of Pittsburgh Medical Center — a system whose clinicians use many different EHR vendors — is an example of what it could do for the VA.

— Remember that optimists say the transition to a single DoD-VA Cerner platform could take 10 years. In the meantime, both agencies potentially will have even greater interoperability challenges than now, because they each will be running two parallel EHR systems—the legacy and Cerner. And with a third of the VA’s patients seeing doctors outside the VA with any of a number of different EHR systems? You start to get the picture….

… The Trump administration Sunday night said it was requesting $85.5 billion in discretionary funding to support VA health care and related services—which is lower than the $88 billion Congress appropriated for the VA last June for 2018. We don’t know if the administration’s numbers will increase when OMB releases a budget addendum later today that reflects the new budget caps Trump signed off on last week with the new spending deal.

Tweet of the Day: Doctor Pat Soon-Shiong retweeted: Los Angeles Times @latimes For the first time in 18 years, we’re returning to local ownership. What do you want the new L.A. Times owner to know? Tell us here http://lat.ms/2EnpVy1

Welcome to Monday morning eHealth, where we hope to start getting a better picture of the real money this week as appropriators dust off their lawyers and agency heads begin lowering themselves into committee room hot seats. Tell us what you’re hearing [email protected], or tweet kernels of wisdom @ravindranize, @athurallen202, @DariusTahir, @POLITICOPro, @Morning_eHealth.

SOME EARLY BUDGET OUTLINES: The president’s document calls for roughly $17 billion in “opioid-related spending” in fiscal 2019, $13 billion of which would go toward prevention, treatment and recovery programs. It also seeks $200 billion for infrastructure, and lays out plans to shrink the federal bureaucracy and gut programs in scientific research, foreign aid, and safety net programs. Now that the White House blueprint is there, lawmakers can have their way with it. “The president’s budget is just a nice book,” Rep. Bill Flores told POLITICO. “It’s good to know where their priorities are, but the ones that make a difference are the ones here.”

FOCUS ON THE FAMILY (PHYSICIAN): The American Academy of Family Physicians wants CMS and ONC to essentially get rid of health IT utilization measures. The group said as much in a letterreleased over the weekend in response to CMS Administrator Seema Verma’s request for proposals to simplify regulation. “Now that MIPS utilizes measures of quality, cost and practice improvement,” the letter says, the academy wants the EHR measuers liquidated. Some requirements are legally mandated, however, so CMS and ONC should work with Congress to chisel away at them. Some other requests: CMS should limit evaluation and management measures and focus its interoperability efforts on enforcing information blocking prohibitions. Too many resources go into box-checking, exchanging useless information and templated record documentation, the letter says. The family docs want more standard clinical data models and consistent quality measure reporting. As for prior authorizations, doctors need more transparent payer pricing and policy information in the clinic, especially as they move to capitated care.

MORE TO DO ON TELEHEALTH: Telemedicine groups, neurologists and lawmakers have applauded the budget deal H.R. 1892 (115) for including the CHRONIC Care Act, but their work isn’t done yet, of course. Rep. Doris Matsuii tells POLITICO’s Mohana Ravindranath that she sees the spending bill language “as a starting point for more legislative action in Congress” on connected care.

— Matsui was one of several representatives urging HHS Secretary Alex Azar and CMS Administrator Verma to use their authority to clarify when telehealth could be used under MIPS. Sens. Brian Schatz and Roger Wicker, who’ve championed telemedicine payment expansion for years, said the measure was long overdue.

AMAZON’S HEALTH VENTURE COULD SUCCEED BECAUSE OF SHEER BARGAINING POWER: That’s one view of last week’s announcement that Amazon, JPMorgan Chase and Berkshire Hathaway are entering into a joint health venture. As we reported last week, tech futurists foresee an Amazon.com-like health marketplace for providers, patients and payers.

— Frank Lichtenberg, a professor at Columbia’s business school, thinks the new unit could lead to a “monopsony,” in other words a buyer-dominated market. The new venture is reportedly starting out by focusing on its combined 1 million employees; with a not insignificant share of the nation’s pharmaceutical purchases, the joint venture might be able to negotiate down prices with drug companies and providers. Add more companies to the mix and there would be more pressure on prices, he told POLITICO.

NEW DRUG CZAR: The White House on Friday appointed deputy White House chief of staff Jim Carroll as its new drug czar. A veteran of the George W. Bush White House and the Ford Motor Company, he has no experience with drug policy other than prosecuting drug crimes in Fairfax, Virginia after graduating from law school. A White House announcement said Carroll “has extensive leadership experience making him eminently qualified.” POLITICO has reported recently that the ONDCP is being marginalized, with most of its functions taken over by a White House team led by Kellyanne Conway. Details here.

RESEARCH: The February issueof the Journal of the American Medical Informatics Association is out, with a long list of research articles that will interest health IT nerds. The issue includes studies of a UDI demonstration project, challenges in electronic clinical quality measure reporting, the development of an EHR-based child abuse alert system, and a study of the impact of EHR record downtime on patient safety … Meanwhile, a new study led by Harvard’s David Bates in the journal BMJ Quality & Safety studied whether doctors get into trouble when they override clinical decision support alerts — a common practice because of the annoyance such software can produce. The researchers reviewed 2,448 over-ridden alerts from 712 patient encounters in 2016 and 2017 at Brigham and Women’s Hospital in Boston. Four out of five overrides were appropriate, they found. But inappropriate overrides led more frequently to adverse events. Their conclusion: “Further efforts should be targeted at improving the positive predictive value of CDS such as by suppressing alerts that are appropriately over-ridden.”

WHAT WE’RE CLICKING:

— Cerner rollout, bad flu season complicate life for Banner Health clinicians and patients in Arizona

— What’s this fax machine thing? Ask medical students entering the world of medicine

— CVS Health bulking up its big data analytics as part of Aetna deal

— Former officials raise questions about Patrick Soon-Shiong, new LA Times owner