Washington, D.C. Update

Corresponding author: Dr. Keith Studdard, 330 E. Algonquin Road, Arlington Heights, IL 60005.

E-mail address: kstuddard@osteopathic.org.

payments to each hospital with certain associated pro- gram costs. The report should be publicly accessible and should clearly identify each hospital, indicating direct and indirect payments, the number of residents Medicare sup- ports, and Medicare’s share of teaching costs received.

During the course of the discussions, several Commis- sioners noted that the June report should present the third and fifth recommendations in the context of the new Health Workforce Commission created by the health reform law.

Rural Health Information Network Work Group meeting

The Rural Health Information Network Work Group re- cently convened to provide insight and information about current and emerging health issues to the Rural Assistance Center, which is based at the University of North Dakota and funded by the HRSA Office of Rural Health Policy.

Health information technology

Neal Neuberger of the Institute for e-Health Policy provided an overview of ARRA HIT provisions. He noted that 70%

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Studdard and Oliva Washington, D.C. Update 119

of rural hospitals may not be able to qualify for Stage 1 of meaningful use. Members of both the House and Senate are currently circulating letters that request the Centers for Medicare and Medicaid Services (CMS) back off proposed requirements in the final rule on meaningful use of HIT. One item of concern mentioned was the exclusion of hos- pital-based eligible professionals from the proposed rule. He also noted that there is an overall shortage of HIT workforce. The Department of Labor estimates that there is a need for 200,000 HIT workers overall. Note: The AOA is in alignment with these efforts regarding meaningful use. The AOA submitted comments to CMS on March 12, 2010 requesting that the agency scale back the objectives for Stage 1 of meaningful use.

Health Workforce Information Center

The center is a one-stop shop for information on health workforce, which includes information on a variety of health professions. Since its launch in February 2009, the center has received more than 100,000 visits. Popular topics include education and training and interest from health professionals seeking information on licensure. The site has received a lot of interest from physicians on the topic of loan repayment. Note: Promotional materials are available to organizations that request it. I would suggest that we ask to receive materials that are available to share information on the Health Workforce Information Center with our members.

Health professions training

Tom Morris, Director of the HRSA Office of Rural Health Policy, provided information on a forthcoming HRSA rural training pilot program. This program, the Rural Training Track Technical Assistance Demonstration program, would provide funding to a consortium of organizations to better understand the challenges that Rural Training Track resi- dency program sites have when recruiting family physicians to train and practice in rural settings. Note: Tom Morris has provided to us initial information on this program. We have contacted the agency and requested additional information regarding the program.

Jerry Connolly, who represents the American Academy of Family Physicians, noted that AAFP is working to get a bill introduced for a five-year year pilot program in four sites that would bring training to community sites with the sole purpose of training primary care residents.

Health information technology certifications programs

The American Recovery and Reinvestment Act (ARRA) which was signed into law on February 17, 2009 creates two

key concepts to determine whether eligible professionals qualify for electronic health records (EHR) incentive pay- ments—they must make “meaningful use” of health infor- mation technology (HIT) and in addition use a qualified or certified EHR. The portion of ARRA that addresses HIT, the HITECH Act, gives the National Coordinator for Health Information Technology authority to establish certification programs for voluntary certification of HIT.

A proposed rule recommending voluntary certification programs for testing and certification of HIT was released by the Office of the National Coordinator for Health Infor- mation Technology (ONC) and published in the federal register on March 10, 2010. This rule is the third and final piece of rulemaking on defining meaningful use of certified EHRs. The other two rules on certification criteria and meaningful use were released by ONC and the CMS, re- spectively, and were published in the Federal Register on January 13, 2010. It is important to note that these rules are closely linked and that CMS and ONC collaborated in the development of these rules. ONC seeks comments on this rule and requests specific recommendations. The complete rule can be accessed at: http://www.access.gpo.gov/su_ docs/fedreg/a100310c.html

This proposed rule creates two certification programs under which HIT can be tested and certified for use by eligible professionals and hospitals to meet requirements specified under meaningful use. The first is a temporary certification program. The program would authorize orga- nizations to test and certify complete EHRs and/or EHR modules. A complete EHR is defined as an EHR that has been developed to have all capabilities meeting all applica- ble certification criteria adopted by the Health and Human Services Secretary. An EHR module is any service, com- ponent, or combination that can meet at least one certifica- tion criterion. Testing describes the process used to deter- mine whether a complete EHR or EHR module can meet specific, predefined, measurable, and quantitative require- ments.

The second program is a permanent certification program that would replace the temporary certification program. The permanent program would differ from the temporary pro- gram because it separates processes required for testing and certification, establishes requirements for accreditation, and establishes specific requirements for ONC authorized certi- fication bodies. The National Institute of Standards and Technology (NIST) would be responsible for accrediting testing entities and determining their competency. Organi- zations in the permanent program would only be able to accept test results from NIST labs when evaluating an EHR for certification. Applicants to the permanent program would need to be accredited before submitting an applica- tion for consideration. Organizations would be required to renew their status every two years. In addition to certifying complete EHRs and EHR modules, participating organiza- tions may be able to certify other types of health informa- tion in the future. This may include personal health records and networks to exchange information.

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ONC expects that the permanent certification program will be operational by 2012. Any organization or a consor- tium of organizations that can demonstrate competency un- der internationally recognized standards can apply for the certification programs. Because of the high level of exper- tise required, it is anticipated that a small number of appli- cants will apply to these programs.

Comments are due by April 9 for the temporary certifi- cation program and by May 10 for the permanent certifica- tion program. ONC anticipates issuing two separate final rules for each of the programs.

Practicing Physicians Advisory Council meeting

The Practicing Physicians Advisory Council (PPAC) held its meeting last week. PPAC member Joseph Giaimo, DO, was in attendance. Among the topics discussed were the Provider Enrollment and Chain, Ownership System (PECOS), EHRs, and fraud and abuse.

EHR update

Tony Trenkle, CMS director of E-Health Standards and Services, and David Hunt, MD, of the Office of the National Coordinator provided an overview of the EHR incentive program and EHR adoption and implementation. The AOA submitted comments to CMS regarding the proposed rule. Dr. Giaimo reiterated some of the concerns of the Associ- ation regarding the proposed rule. Dr. Giaimo said the Stage 1 requirements are too aggressive and will deter participa- tion. PPAC adopted his recommendations that CMS remove the numerator/denominator measurement calculations until the EHR systems can do automated calculations. He also recommended that CMS develop a feedback mechanism so that physicians will know that they transmitted the data successfully and are meeting the criteria. One of the criti- cisms regarding the Physician Quality Reporting Initiative

is that physicians do not know if they are meeting the reporting criteria until after the reporting period has ended. By that time, they have no opportunity to make corrections. In addition, Dr. Giaimo expressed support for the Physician Consortium for Performance Improvement in developing physician quality measures. Other PPAC members recom- mended that CMS modify the requirements so that hospital- based physicians are eligible to participate.

PECOS

James Bossenmeyer, CMS director of the Division of Pro- vider/Supplier Enrollment, gave an update on PECOS. He noted that CMS has postponed its plans to reject claims of ordering/referring physicians until next January so that phy- sicians have more time to enroll or update their enrollment in PECOS. PPAC members said CMS needs to do tremendous outreach to the physician community until next January.

Fraud and abuse

Kimberly Brandt, CMS Director of the Program Integrity Group, described the agency’s initiatives such as the DME Stop Gap Plan and HEAT. Under the stop gap plan, CMS identifies highest-risk DME suppliers, highest-ordering physicians, and highest-using beneficiaries. The agency conducts data analysis, interviews physicians to validate their NPI, and verifies clinical relationships. The hot spots for DME fraud are New York, North Carolina, Florida, Michigan, Texas, Illinois, and California. CMS revoked 265 DME suppliers. CMS is also working with the American Medical Association on how to help doctors bill correctly for DME supplies. PPAC recommended that CMS show that physicians represent the extreme minority in fraud and abuse cases. There are HEAT Strike Forces in Miami, Los Angeles, Houston, Detroit, Brooklyn, Tampa, and Baton Rouge. The Strike Force teams investigate and prosecute fraud across all benefit types.