The budget bill passed by Congress on Friday morning includes several health information technology provisions for which provider organizations generally voiced support.
In particular, it includes changes to the Electronic Health Record Meaningful Use Program designed to reduce burdens on providers and keep more of them in the program. The bill also makes beneficial changes to the MIPS payment program that rewards doctors for quality care and improved outcomes.
Provider trade associations were pleased with much of what they saw in the bill.
“The Bipartisan Budget Act of 2018 is largely a win for physician practices,” according to the Medical Group Management Association representing larger provider practices. “Reducing burden in the MIPS program, eliminating the unelected Medicare cost-cutting board known as the IPAB and averting a flawed mis-valued code policy that would have resulted in drastic across-the-board payment cuts in 2019 and 2020 are all top MGMA priorities.”
In the MIPS program, physicians were expected to reduce costs by 10 percent annually to start, and eventually reach cost reductions of 30 percent. Through provisions in the bill, physicians can stay at the 10 percent rate through 2021.
The American Hospital Association highlighted a provision to delay for two years cuts to payments to Disproportionate Share Hospitals, which are critical to caring for the most vulnerable patients, as well as extended funding of the Children’s Health Insurance Program for four more years, thus extending the program for a total of 10 years. The group also lauded new funds to fight the opioid epidemic.
“We applaud provisions in the bill that repeal the Medicare payment caps for outpatient therapy services, give hospitals more flexibility on meaningful use and increase the availability of telehealth services,” AHA notes. “The bill also supports chronic care management, including policies that advance team-based care, expand innovation and technology, empower individuals and caregivers in care delivery and allow patients to receive more care in their homes.”
To reduce the number of providers participating in the meaningful use program but seeking hardship exemptions, the bill removes a mandate that meaningful use standards become more stringent over time, which will aid providers while also enabling the Department of Health and Human Services to be more deliberative in evaluating hardship requests, according to the College of Healthcare Information Management Executives (CHIME), a trade organization representing chief information officers and other health IT executives.
Further, eligible professionals (non-hospital based physicians), eligible hospitals and critical access hospitals can be exempted from reductions in Medicare payment rates if they can show that participating in meaningful use is a significant hardship. These providers must apply for a hardship exemption and give proof of the hardship on an annual basis for up to five years, according to the Centers for Medicare and Medicaid Services.
Provisions in the bill will enable physicians to skip Stage 3 of meaningful use and stay in Stage 2, using their 2014 electronic health record systems, saving effort and money by not having to update their EHRs to meet new requirements, says Robert Tennant, director of health information technology policy at the Medical Group Management Association.
Another provision, administered by states, will enable physicians with at least 25 percent of patients covered under Medicaid or covered pro bono to receive an extra $8,000 a year and they don’t have to buy new EHR technology; the program that runs through 2021, Tennant notes. This could keep more Medicaid providers in the program.
CHIME leaders said they are encouraged to see the budget bill include provisions of H.R. 1148, the Furthering Access to Stroke Telemedicine Act of 2017, which expands the ability of patients presenting at hospitals or mobile stroke units to receive a Medicare-reimbursed neurological consultation via telemedicine technology.
“Many of our members seek opportunities to expand telehealth services within their organizations, and the inclusion of telestroke and teledialysis policies is an important step forward to further telehealth adoption across the country,” says Cletis Earle, chair of the CHIME board of trustees.
Other IT provisions include easing access to telehealth services for Medicare Advantage enrollees, enabling accountable care organizations to expand use of telehealth and expanding use of telehealth to stroke patients. CHIME also applauds a $6 billion appropriation in the bill to combat the opioid crisis.
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