CR contains telehealth, ACO, meaningful use goodies

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

CR CONTAINS A LOT OF HELP FOR HEALTH IT: The House has passed a bill to keep the government running through March 23. If the latest congressional kicking of the can doesn’t have you that excited, perhaps the bill’s more permanent measures might.

The bill includes several provisions promoting various aspects of health IT. It includes large portions of the Senate Finance Committee’s CHRONIC Care Act ( S. 870 (115)), which aims to boost chronic care management and telehealth reimbursement for Medicare Advantage plans. The resolution also expands telehealth reimbursement for stroke treatment, among various other enhancements for telehealth.

The bill also tweaks meaningful use regulation, incorporating Rep. Michael Burgess’s de-escalation bill (HR3120), which removes the HITECH requirement that EHR stimulus asks steadily increase.

Industry groups were universally happy with the bill — while keeping in mind that any changes also have to pass the Senate.

“We are very hopeful these provisions stay in the Senate version. The language is bicameral and bipartisan so we are hopeful,” said the Alliance for Connected Care’s Krista Drobac.

Joel White of Health IT Now said inclusion of the bills was “the beginning of a much-needed shift that will pay dividends in better health care outcomes and reduced costs.”

“We are extremely supportive and have championed each,” said CHIME’s Mari Savickis, who hoped that the telehealth provisions would spur growth. As for the meaningful use escalator clause, “removing it will bring much needed stability and relief to our members,” she concluded.

SOON-SHIONG, NEW LA TIMES OWNER: Patrick Soon-Shiong is close to finalizing a deal making him the new owner of the Los Angeles Times and San Diego Union-Tribune, several outlets are reporting. As longtime Morning eHealth readers know, Soon-Shiong has a polarizing reputation, having sold a pair of pharmaceutical companies and shepherded a successful cancer drug into the clinic, on one hand — and having faced persistent accusations of benefitting from conflicts of interest. (Here’s our reporting on POLITICO, as well as reporting from Stat.)

The move expands Soon-Shiong’s holdings all the broader: he manages seven hospitals, two public companies, and has a stake in the Los Angeles Lakers, among much more. He’s also expanded his political reach, having been appointed to the Health IT Advisory Committee by Paul Ryan. He’s also met with multiple administration officials.

eHealth tweet of the day: Esther Choo @choo_ek But using incessant charting as a measure of the quality of a doc is a rough metric in this day and age. I get emails every day about my documentation. Never about my bedside manner. Never.

WEDNESDAY: One of the incredible features of moving is the relative effectiveness of various institutions in tracking you down. Junk mail found your correspondent a mere eight days after his move. Think that’s an incredible feat? A certain cable company managed to start trying the upsell one day after installation. Compare modern-day feats at [email protected]. Sing a song of great accomplishments in salesmanship on social media at @ravindranize, @arthurallen202, @dariustahir, @POLITICOPro, @Morning_eHealth.

New! Pulse: State Health Care Newsletter - Starting Feb. 9 - Pulse: State Health Care is a weekly newsletter for POLITICO Pro customers with a focus on health policy in the states. Our newsletter expands coverage to include critical policy intelligence on waivers, and decision-making in state capitols. Sign up today.

FDA GETS COMMENTS: FDA’s long-awaited clinical decision support guidance, unveiled back in December, has finally gotten its fair share of comments. And while everyone tries to be polite, the comment letters have some rather baldly stated concerns.

Take for instance the CDS Coalition, run by Epstein, Becker, and Green’s Bradley Merrill Thompson. Perhaps it’s not a big surprise that the Coalition claims the guidance “violates federal law and policy,” given Thompson’s previous criticism of the guidance, but it’s not something we expected to see anyway.

The coalition’s criticisms center around the lack of a risk-based approach for calibrating FDA oversight. But the group is also very concerned about one specific technology: machine learning. Indeed, letters from the American Medical Informatics Association and College of Health Information Management Executives all want to know more about machine learning.

You may recall the technique from discussions surrounding that much-hyped Google research article — about which we’ll discuss more later — but it essentially involves computers “discovering” connections between data on its own. That can lead the computers to make rather sharp, unexpected predictions, which is both the attraction and the fear with the technology.

On the pro side, this technique can lead to connections between pieces of data you wouldn’t have expected to be connected, and thereby lead to more insight. On the con side, it can lead to bizarre, wrong connections that the viewer would have difficulty second-guessing.

The problem is particularly acute for FDA and clinical decision support. If doctors can look into the source of computers’ predictions or connections, FDA envisions less agency oversight. If they can’t, they envision more. That invites worries, though each organization has a slightly different variant.

“[A]s technology is rapidly evolving and machine learning evolves — we will see more decisions being made automatically by the computer without the opportunity for a clinician’s review,” CHIME cautions, before arguing that some cutting-edge institutions have the capabilities to oversee their CDS themselves. At any rate, the agency needs to clear up gray areas around the data sources — the warehouses — for these CDS, they letter argues.

The CDS Coalition is a bit more laissez-faire, arguing that the risk of the condition is a relevant factor. For example, even if you have a black box algorithm, it’s not a huge concern if it’s trying to make a good diagnosis for the common cold, the letter states.

AMIA is more neutral on the subject of machine learning, arguing that FDA should convene a meeting of some sort to discuss matters in more detail.

— Unintended Cures consequences at FDA: There are some unintended consequences from 21st Century Cures ( HR34) on FDA, agency commissioner Scott Gottlieb warned Tuesday. The legislation allowed the agency to bust through federal salary schedules in some instances; while the provision was intended to empower the agency to attract handsomely remunerated private sector talent, Gottlieb worries that there may be some side effects. It creates “issues around have and have nots,” Gottlieb said, as talent from some parts of the agency might migrate to other parts, where they can be paid more.

GOOGLE PAPER’S EXCITING PROTOTYPE: Researchers and tech mavens are very excited by the recent Google-driven paper describing a predictive analytic model, your correspondent found. The authors of the paper – 35 in all – threw thousands of hours in computing time at hundreds of thousands of patients’ de-identified data, finding you could predict all manner of adverse events reliably.

But that’s only the beginning of the problem. It’s one thing to predict an adverse event; it’s another to avert it. We chatted with some experts about some of the issues. Pros can get the rest here.

NEW IN THE AGENDA — THE DIGITAL DIVIDE: In POLITICO’s newest issue of The Agenda, the Pro technology team looks at ways technology distributes economic prosperity unequally across the map, and disparities in Americans’ access to technology. The digital divide creates two classes of Americans: those who can easily access the wired world, and those who struggle, whether because of geography, age or economics, to connect.

Among the special reports is one from Margaret Harding McGill, who traveled to a remote corner of rural Idaho to find the least-connected people in America and ask if the FCC’s incentives are working to help them hook up to broadband internet. The full story here. Arthur Allen, editor of the e-health team, looks at a promising effort by former Google engineers to solve a puzzling challenge in community health. Full story here.

STEADY AS IT GOES IN KC: Cerner earned slightly less than anticipated in the fourth quarter because of the VA’s decision to hold off signing its estimated $10 billion EHR contract with the company. On a quarterly earnings call Tuesday, Cerner executives said the company had spent considerably to ramp up hiring and deployment of personnel to start the project--but said the short-term financial impact of that investment would be brief. “We expect the contract to be signed soon,” said President Zane Burke, adding that Cerner was confident its interoperability capabilities were strong enough to meet the VA’s requirements.

— Meanwhile, at the DOD: The current eight-week pause in the Cerner’s MHS Genesis project with the military is not a setback but rather a “planned exercise,” Burke said. Various sources close to the project say the pause was decided on late last year as clinicians reported a growing number of problems with the implementation.

— Overall: The vendor reported $2.3 billion in bookings during the quarter — an all-time high for the company — and experienced strong interest in its population health and other software, according to its quarterly report. Most of the lost VA income was offset by other unanticipated contract signings, the company said.

STAT OF THE DAY: A quarter of residential care communities had an EHR in 2016, the CDC reported.

WHAT WE’RE CLICKING ON:

—Houston health executive takes his dad through cancer care — and discovers the system stinks.

—So where are we at in the digital health hype cycle?

—One Apple executive who’s spent his career pondering the reinvention of research has left the company.

—Journal of General Internal Medicine perspective argues EHRs are pretty much a complete bust.
Ascension Health is upping its investment in telehealth.