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Provider group recommends federal officials instate incentives for long-term care providers to adopt EHR

Posted on August 28, 2012 | No Comments

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Long-term and post-acute care providers and officials from the Office of the National Coordinator (ONC) for Health Information Technology recommended that Electronic Health Records (EHRs) design requirements focus on longitudinal care plans, transitions of care and patient assessments during a roundtable discussion held in May. A report summarizing the roundtable discussion stated that federal health officials should offer long-term care providers incentives to adopt Stage 3 Meaningful Use criteria for EHR.

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The U.S. Department of Health and Human Services (HHS) issued a 563-page omnibus rule yesterday afternoon. The rule updates the Health Insurance Portability and Accountability Act (HIPAA) privacy and security regulations, as required under the American Recovery and Reinvestment Act of 2009. Notably, the rule expands direct liability for breaches to contractors, subcontractors and other associates of healthcare providers, plans and insurers. In addition, the rule outlines noncompliance penalties, which vary depending on level of negligence and are capped at $1.5 million. The rule also expands patient rights, such as improving electronic medical record access and enabling patients to limit disclosure of out-of-pocket payments for treatments. HIPAA-covered entities and business associates must by in compliance with the new regulations by September 23 of this year. The final rule will be published in the January 25 Federal Register.
A previous Implementation Brief discussed the electronic health record (EHR) incentive program enacted by the HITECH Act, which is part of ARRA[1]. Stage 1 of that program began in 2011 and the Centers for Medicare and Medicaid Services (CMS) reports that through July 2012, more than $6 billion in Medicare and Medicaid incentive payments had been made to 132,511 physicians and hospitals that demonstrated meaningful use of EHRs[2]. On August 23, 2012, CMS published a final rule on the Stage 2 Meaningful Use criteria that eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs) must meet to qualify as meaningful users of electronic health records (EHRs) and receive incentive payments under the Medicare and Medicaid programs[3]. This final rule builds upon the Stage 2 proposed rule, released on March 7, 2012. The Stage 2 final rule also revises certain Stage 1 criteria, which were finalized in the July 28, 2010 final rule[5]. Stage 1 of the incentive program was designed to encourage providers to move key clinical data into an electronic format, and focused on establishing the functionalities of a certified EHR system[6]. With the final rule, CMS continues its incremental approach to continuing this transitional process and strikes a balance between stakeholders calling for Stage 2 to require demonstrated improvements in care as a result of EHR use and those seeking more flexibility in the rules, with incentives simply to acquire EHR technology.
The health reform law makes no major revisions to provisions of the American Recovery and Reinvestment Act (ARRA) of 2009 to move the nation toward a national health information policy and create incentives for the adoption and meaningful use of health information technology (HIT). However, because the adoption and use of HIT is foundational to the implementation of many aspects of health reform, this entry summarizes the key provisions of the 2009 law.
A new report released by the University of Massachusetts Medical School (UMMS) and the National Academy of Social Insurance (NASI) examines the establishment of the information technology (IT) infrastructure to promote access to and enrollment in health plans through Exchanges and expanded Medicaid programs under the Affordable Care Act (ACA). The report reviews lessons from “Early Innovator” and other advanced states as they prepare for these ACA provisions. The report, entitled "Establishing the Technology Infrastructure for Health Insurance Exchanges Under the Affordable Care Act," reviews issues that policymakers should consider as they develop state-based technology infrastructures.
The National Association of Medicaid Directors sent a letter to the Centers for Medicaid and CHIP Services (CMCS) Director Cindy Mann including recommendations on how to improve federal policies and procedures regarding managed long term supports and services programs.
A growing number of state Medicaid agencies are planning to launch or expand programs that offer risk-based contracts to managed care organizations (MCOs) to provide long-term services and supports (LTSS)—and, in some cases, acute and primary care—to older adults and people with disabilities. Because these individuals often have one or more chronic health conditions, they tend to use more health services than younger people and people without disabilities. In addition, they often depend on other services and supports such as personal care to perform activities of daily living, such as bathing and eating. In risk-based managed care arrangements...
The Congressional Budget Office presents the long-term budget outlook under two scenarios in a new report. These scenarios embody different assumptions regarding future policies governing federal revenues and spending. The first, the extended baseline scenario, reflects the assumption that current laws generally remain unchanged and that lawmakers will allow changes that are schedule under current law to occur, forgoing adjustments routinely made in the past that have boosted deficits. The second, the extended alternative fiscal scenario, incorporates the assumptions that certain policies that have been in place for a number of years will continue and some provisions of law that might be difficult to sustain for a long period will be modified. These two scenarios span a wide range of possible policy choices. The report focuses on the next 25 years and gives special focus to outlays for major health care programs. Under both scenarios, the report estimates that total outlays for federal health care programs will grow much faster than the gross domestic product (GDP), increasing from 5.4 percent of the GDP in 2012 to nearly 10 percent in 2037. National health care spending is also expected to rise. Health care expenditures is expected to increase to almost one-quarter of the GDP by 2037. CBO suggested that key factors contributing to this growth in spending have been the emergence of new medical technologies, rising personal income, and the expanding scope of health insurance coverage.
The Patient Protection and Affordable Care Act (ACA) has the potential to help States reorient their systems of long-term care. The goal is to move away from nursing homes and institutional care and toward a greater emphasis on home- and community-based services. This will enable States to both meet a broad range of needs and support family caregivers. The report, "How The Affordable Care Act Can Help Move States Toward A High-Performing System Of Long-Term Services and Supports," published by Health Affairs, outlines five key characteristics of a high-performing system of long-term services and supports. The paper describes an emerging "scorecard" that could help measure states' progress toward this goal. Finally, the Health Affairs piece highlights aspects of the ACA which will support the creation of such a high-performing system for the disabled and those with chronic conditions.
Today researchers at The George Washington University’s Hirsh Health Law and Policy Program launched Health Information and the Law (, a website designed to serve as a practical online resource regarding federal and state laws governing access, use, release, and publication of health information. The site addresses the current legal and regulatory framework for health information, as well as changes in the legal and policy landscape that have an impact on health information law and its implementation particularly as health information moves into an electronic phase. Health Information and the Law will enable cross-state comparisons and analysis of state and federal law on key health information issues, including how the revolution in the creation, collection, and exchange of health information affects...