mgma letter

8/14/2019 MGMA Letter

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of these types of measures. In the case of pat ients receiving tests, forexample, p h ysic iansc learly cann ot force pat ients to un dergo tests w h ich (i)may be ph ysical ly uncomfortable for the pat ient , ( i i) one th at the pat ientobjects to , or (ii i) one for wh ich the pat ients health plan covers onl y part oft he cost, or none of the cost .

Se lect ion o f cr i t e r i a a lready in wi despread use It iscr i t ical to avoidim p osi ng cr i teria that do not have widespread experience in the smal l andrural c l i n ical sett ings. To ensure that m eanin gful use can be successfu l ly

adop ted in a wide range of pract ice set t ings, i nc lud ing smal l physic ian andrural pract ices, we strongly encourage you to adopt t he approach takenthrough the govern ments elect ronic prescr ibing rulemaking process. Assetout in the Medicare Prescr ipt ion Drug, Improvement , and Modernizat ionAct of 2003 , the H HSSecretary is only to adopt standards that have widein d ustry usage an d to co n d uct pi lots to determi ne the appl icabi l i ty of anyaddi t ional standards. We believe a simi lar approach for determini ngappropriate mean ingful use criteria should be adopted .

Se lect ion o f appropr ia te ad m in ist rat ive cr i ter ia The admin istrativetransact ionscurrent ly out l i ned in the meani ngful use matrix that ph ysicians

would have to report do not take into accoun t the real i ty of current pract iceworkf low or the i neff ic ie ncy of the current standards themselves.

o In the case of the elect ronicc laim standard man dated un der theHeal th Insurance Portabi l i ty and Accountabi l i ty Act of 1996 (H IPAA),the ANSI X 12N 4010A1 837, the majority of smal l and medium-sizedpract icescurrently util ize a c learinghouse or bi l l ing service to submi tc la ims to health plans for payment . In many cases these cla imsoriginate as paper CMS 1500 forms or other, non-HIPAA compl ian tformats. In addi t ion , t he current compl iance date for the latesti terat ion of the HIPAA 837 stan dard (5010) is not unt i l Jan .1, 2012,well after the 2011 start date for th e EHR in centive program .

o T he current pat ien t insurance eligibili ty verif icat ion standard (A NSIX12 N 4010A1 270/271) is not widely used by providers because ofthe lack of standardizat ion among health plans. W hi le th isstandardizat ion issue has been addressed somewh at by the Counc i lfor Affordable Qual i ty H ealthcare Com mittee on Operat ing Rules forElect ronic Transact ions (CAQ H CORE), the C ORE operating rulesremain vol untary for health plans an d to date not widely used in thein d ustry . As with the 837, t he compl iance date for the 5010 versionof the 270/271 transact ionsstandards is not unt i l Jan . 1, 2012.

I nst i t u te a p i lo t O nce the f inal rule is published , and well before to the2011 program start date, we bel ieve that the governmen t should conduct ap i lo t wi th a small nu mber of vendors an d in a variety of physician pract iceset t ings to ensure that the process of demonstrat ing meaningful use isachievable and pract ical . T h is pilot could assist in determin ing potent ialroadblocks to program success and ident i fy solut ions to those roadblocks.

Program log ist ica l suppor t - To avoid physicians encoun tering problemsduring the meani ngful use reporti ng process, we bel ieve that t hegovernment should:


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o Ensure timely respo nses f rom C MS to ph ysicians o nce data aresubmit ted in support of their meanin gful use report ing requiremen ts.

o The government m ust be ready to accept meanin gful use data in late2010 in order for ph ysic ians to send test data, receive feedback froman appropriate govern men t agency and st i l l have suffic ient t ime totake the appropriate act ion to modify their syste m should theyencounterdata conten t or report ing problems.

F l ex ib i l i t y i n ach i ev in g mean in g f u l use - Rather than develop the programwi th a simp l ist icpass/failstructure, we recommend tha t physic ians begiven a report on their meani ngful use achievement and sufficient t ime torestr ucture/modify their syste ms an d submi t corrected data to achieve ful lmeaningful use durin g a particular reporti ng period .

D e m o nst ra t ion o f mean ing fu l use -- Creatin g a process that is effect ive yetsim ple for physic ian pract ices to demonstrate meani ngful use will be acr i t ical compone nt of a successful incentive program . We recommend tha tattestation and/or survey inst rumentsserve as the primary methods ofdemonstrat ion . T h is would be especial ly imp ortant for the init ial phases of

the program an d could be verif ied through a n audit process.

T hedevelopmen t of a compl icated and t ime-consuming process for pract ices toprove that they meet the incent i ve qual i ficat ions will result in fewerorganizat ions transi t ioning to EHRs.

Si m p l i fi e d p h ys i c i an a t t est a t i o n The process for ph ysic ians todemonstrate that th ey have achieved meani ngful use should be simple andf lexible enough so that physic ians in al l types an d sizes of pract ice can attestt h is to the governme nt . W e strongly encourage that self-attestat ion be theprimary attestat ion approach adopted . In addi t ion , m uch l ike physician useof th e data registries for PQ RI reportin g, th ird party attestat ion should a lsobe considered.

C lose ly mon i to r the EHR marke tp lace Section 3007 (a) of the ARRAlegislat ion requires that the National Coordinator shal l support thedevelopmen t and rout in e updat ing of qual i f ied elect ronic health recor dtechn ology (as def ined in sect ion 3000) co nsistent wi th subsect ions (b) an d(c) and make avai lable such qual i f ied electronic health record technologyun less t he Secretary determines through an assessmen t that the needs an ddemands of providers are being substant ial ly an d adequately met throughthe marketplace. We encourage th e c lose mon itoring of the EHRmarketplace to ensure that appropriate and cost-effic ient products are bein goffered to physic ian pract ices, espec ial ly small pract ices with l im i tedf inancial resources. We also encourage the early recognit ion of marketplacefailures an d subsequent deploy ment of an appropriate low-cost al ternat iveE HR software product and support ing str ucture .

Sim p l i f y t h e rep o r t i n gprocess-- Qu ality reportin g is a central element ofmeaningful use. Allowi ng pract ices of varying soph ist icat ion th e abi l i ty toreport the q ual i ty data ut i l iz ing various methodologies (i e,c laims-b ased ,data registries, an d summary c l i n ical data transmitted direct ly via the EH R)would ensure that as broad a group of pract ices as possib le would have theabi l i ty to move forward with adoptio n of HIT ,successful ly report qual i tymeasures and q ual i fy for the incent ives. In addi t ion , i t iscrit ical that th is


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report ing requirement take in to account current reporting programs to avoiddupl icative efforts.

I nst i tu te a process to test p h ysi c i an repor t ing syste ms -- Many pract icespartic ipat ing in the Physic ians Quality Report ing In it iat ive programdiscovered after the program had ended for the year that they did notqual i fy for the incent ive payments. In order to avoid ph ysic ian pract icesexperiencing a sim ilar problem for th e ARRA in centive program , werecom mend th at the governmen t develop a process where physic ian

pract icescould submit their software spec if icat ions, test their qual i ty datareport ing met hodology and receive t imely and act ionable feedbackregarding their ability to qualify for the incent ive payments.

Recogn ize t im e const r a i n tsW e conten d that the 2011 start date for theincentive program prec ludes the development an d deployment ofsignif icant addi t ions to the criteria required for certif icat ion .Si nce theprocess of software ident if icat ion , acquisi t ion , implementat ion and test ingtyp ical ly takes one to two years, t he co nsequence of adding requiremen tsthat are not current ly required in CCHIT-certif ied syste ms wil l most l ikely besignif ican t ly slowed software developmen t . T h us, m an y p h ysic ians would

lac

k the opportun ity to qual i fy for the inc

ent ives

un til well after 2011.

Meaningful use shoul d be def ined in a way that al lows p h ysic ian pract icesand t heir EHR vendor partners to meet the in cent i ve requiremen ts wi threasonable effort and w ith out un due burden .

C lose ly m on i to r p rov ider and ven dor p rogress W hat has been out l inedin the legislat ion for 2011 an d beyond is noth i ng less tha n a transformationof the health in formation in frastr ucture of the nation . It will be crit ical tocont inuousl y assess the readiness of physic ian pract ices to meet thischal lenge and qu ickly identify barriers to the successful adoption of HIT andsolut ions to those barriers.

In addit ion to mo nitoring the provider sector of the ind ustry,

we stronglyencourage HHS to oversee the vendor comm uni ty to ensure that th ey areable to meet the dema nds of the market . If the ARRA in centive program isviewed in a posi t ive man ner by the majority of ph ysic ians, th ere will be asignif ican t surge in the number of pract icesseeking to purchase and instal lE HRs. T h is ra ises t he specter of potent ial ly lengthy in stal lat ion queues,h asty instal lat ions that resul t in sub-opt imum c l i n ical performance,i nsufficient maintenance support ,slowed upgrades, delayed customizat ion,and the possib i l i ty of un fair busi ness pract ices and i nf lated prici ng. We urgeH HS to aggressive ly scrut in ize the EHR vendor sector , establ ishi ng toll-freete lephone num bers and a Websi te al lowi ng physic ian pract ices and others toreport problems, issues, an d unfair busi ness pract ices.

P h ysic ian pract ice outreach T he success of the ARRA incentive programwil l rely in part on effect ive outreach to the physic ian pract ice co m m u n i t y .T imel ines, def init ion s, program modif icat ions, updates and t he appl icat ionprocesses al l must be co m m u n icated direct ly to the potent ial incent iverec ip ients. We recommend tha t HHS develop a multi-prongedco m m u n icat ion process that includes, but is not l im ited to:

o An easy-to-navigate Websi te with a comprehensive FA Q sect ion .o Toll-free telephone nu mbers to provide accurate informatio n .


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o Regularly-scheduled open door Webinars to provide updates an daddress partic ipant quest ions.

o Partic ipat ion by H HS offic ials at industry conferences and forums.o Direct outreach to prov ider trade assoc iat ions.

In co nc lusio n , M G M A strongly supports the object ives of the ARRA incent iveprograms to st im ulate adoption of HIT . However, in order to maxi mize the successof the program , we bel ieve that an appropriate def init ion of meani ngful use andprogram logist ics m ust be developed . Should th e qual i f icat ions for partic ipat ion in

t hese i ncent i ve programs be overly str ingent or the process too onerous, t hegovern ment runs the r isk of exclud ing a large percentage of physic ian pract icesf rom part icipat ion.

T h is is a h istoric opportun ity to reform and revital ize the nat ion s health caresyste m . However,co nsiderable work must be accompl ished in order to makeeffect ive HIT widely avai lable. We look forward to working with H HS to fac i l i tatethe physic ian pract ice transi t ion to EHRs an d make the promise of improvi ng thenat ion s health care system through techn ology a real i ty .

Si ncerely,

Wi l l iam F.Jessee , M D , FACM PEPresident and C hief Executive Off icer

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