Thirty-seven Democratic members of the U.S. Senate have sent a letter to Health and Human Services Secretary Kathleen Sebelius asking for changes in the proposed meaningful use rule.

In particular, the senators ask that HHS move from its "all or nothing" approach and give some flexibility to meeting meaningful use criteria. They also suggest changes to the definition of "hospital-based physician" to enable more to qualify for incentive payments. Further, they urge HHS to fix unintended consequences of using Medicare provider numbers to identify hospitals receiving incentive payments. What follows is full text of the letter, sent on March 30:

"We commend your work to advance the adoption and meaningful use of health information technology (HIT) by health care providers.  The potential of HIT to promote high-quality patient care and to reduce waste is widely viewed as a necessary and vital component of the future of American health care.

"The American Recovery and Reinvestment Act, enacted in February 2009, included significant new investments to encourage the meaningful use of health information technology through the Health Information Technology for Economic and Clinical Health (HITECH) Act.  As a result of HITECH, the Congressional Budget Office has estimated that health information technology adoption rates will be 70 percent in hospitals and 90 percent among physicians.

"We are encouraged by the Notice of Proposed Rule Making published by the Centers for Medicare & Medicaid Services on Jan. 13, 2010 regarding meaningful use of HIT.  The proposed rule requires hospitals and eligible professionals to satisfy specified objectives in order to be considered a "meaningful user" and to receive incentive payments.  We strongly support the proposed rule's fundamental goals of improving quality, safety and efficiency while reducing health disparities, engaging patients in their health care, improving care coordination, and ensuring adequate privacy and security protections for personal health information.  We believe the proposed rule lays important groundwork for achieving these goals.    

"To help ensure success in achieving meaningful use, we recommend that the proposed rule be modified from its current 'all-or-nothing' approach to one that allows providers to defer a limited set of criteria under Stage 1 of meaningful use while preserving a floor of mandatory functional use requirements, as recommended by the HIT Policy Committee.  The deferment would only be temporary, as all criteria should be met over the course of the incentive payment program. This approach would make significant advancements toward adoption and meaningful use of HIT while allowing an appropriate amount of flexibility for eligible professionals and hospitals.  While we believe that the general implementation framework outlined in the proposed rule should be preserved, starting with a phased, flexible approach to meaningful use would be a constructive change.

"In addition, despite legislative intent, outpatient physicians practicing adjacent to hospitals were excluded from HIT incentive eligibility, making it more challenging for these providers to receive the HIT incentives.  A technical correction to ameliorate this oversight has been included in the American Workers, State, and Business Relief Act, which recently passed the Senate.

"However, we ask that you use your administrative flexibility to rectify this concern, regardless of the outcome of the pending legislation.

"Finally, the use of Medicare provider numbers to distinguish hospitals for the purpose of receiving incentive payments for meaningful use may create some unintended inequities.  A single provider number can sometimes encompass multiple campuses for a hospital system.  Therefore, a hospital system with multiple provider numbers will be eligible for more incentive payments than would be a hospital system of equal size with a single provider number.  We urge you to consider how this shortcoming could be best addressed.

"We appreciate your consideration of these concerns and your assistance in appropriately addressing them in the final rule.  We look forward to working with you to ensure that the implementation of HITECH delivers on the promise of HIT to improve quality and efficiency in the health care system."


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