A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Health Information

Implementation Briefs

Rating the Quality of Qualified Health Plans Sold in the Marketplace

Categories: Health Care Quality and Delivery System Reform, Health Information

Posted on January 7, 2014

On November 19, 2013, the Obama Administration published a Notice with comment that describes the overall Quality Rating System (QRS) framework for rating the quality of health plans (QHPs) sold in the health insurance Marketplace (another term for Exchanges). The purpose of the Notice is to solicit comments on the framework. Comments must be received by January 21, 2014. Comments are sought on both the proposed quality measures that QHP issuers would be expected to report, as well as on ways to preserve the integrity of QHP ratings and on areas for future measurement...

Reporting to the National Instant Criminal Background Check System and the HIPAA Privacy Rule

Categories: Health Information

Posted on August 21, 2013

On January 16, 2013, in the wake of the Newtown shootings, President Obama announced 23 executive orders aimed at reducing gun violence, including an instruction to the Department of Health and Human Services (HHS) to address any potential legal barriers to reporting to the National Instant Criminal Background Check System (NICS). On April 23, 2013, HHS issued an Advance Notice of Proposed Rulemaking (ANPRM) requesting public comments on whether the HIPAA Privacy Rule presents a barrier to reporting of individuals who should be prohibited from possessing firearms for specified mental health reasons (such as involuntary commitment to a mental institution).

Health Information Implications of the 2014 HHS Budget

Categories: Health Information

Posted on May 29, 2013

On April 10, 2013, President Obama released his proposed FY 2014 budget, which includes $967.3 billion in outlays for the Department of Health and Human Services (HHS) and makes legislative proposals that would save an estimated $361.1 billion (net) over ten years. In conjunction with the release of the President’s budget, HHS published an overview of the budget provisions for HHS, which provides more detail on how the Department would allocate its budget in FY 2014 and describes its ongoing progress in meeting specific program goals and legislative requirements. Many of the proposals included in the President’s budget and HHS’ overview relate to the ongoing transformation of the health care delivery system to a value-based system that rewards quality and efficiency. Critical to the success of this transformation is the exchange of health information for activities such as quality measurement and reporting, value-based purchasing, consumer engagement, and comparative effectiveness research. Below are selected provisions of the HHS budget, the agency’s relevant legislative proposals for 2014, and progress reports for health care system reform efforts that require the use and exchange of health information. We also identify HHS’ stated priorities for 2014 that are related to health information...

Transforming Health Care Delivery

Categories: Health Care Quality and Delivery System Reform, Health Information, Health Insurance, Long Term Care, Medicaid and CHIP, Medicare

Posted on January 16, 2013

Experts and stakeholders agree the current health care system is unsustainable. By 2020, health care spending will comprise almost 20% of the gross domestic product. Furthermore, an ever growing body of evidence clearly indicates that the system is not experiencing improvements in quality that are reflective of the cost growth. The Patient Protection and Affordable Care Act (ACA) takes significant strides towards the transformation of the American health care delivery system from a system that rewards volume to a system that rewards quality and value. The programs and initiatives...

Update: AHRQ Project to Develop a Health Information Rating System

Categories: Health Information, Implementation Update

Posted on January 9, 2013

Previous implementation briefs have addressed the electronic health record (EHR) incentive programs enacted by the HITECH Act, part of ARRA. These programs financially incentivize adoption of EHR technology that meets standards of interoperability and accessibility, among other criteria, and incentivize providers to use the technology to engage with patients and improve patient care. Among other goals, the EHR incentive program is intended to improve patient...

Improving Care Coordination – Spurring Use of Health Information Technology in Long-Term Care

Categories: Health Care Quality and Delivery System Reform, Health Information, Long Term Care, Medicaid and CHIP, Medicare

Posted on November 14, 2012

Historically, the American health care system through its siloed delivery and reimbursement models has failed to support a patient-centered and coordinated delivery system. Fragmentation has resulted in a health care system where potentially avoidable hospital readmissions, duplicative testing, and medication errors are common. Widespread adoption and use of Health Information Technology (HIT) has the potential to decrease these occurrences by enabling providers to electronically exchange health information with other providers and their patients across settings of care to better coordinate patient care. Recognizing the potential benefit of widespread use of HIT, in 2009 Congress authorized...

Update: Health Information Technology – Adoption Incentives

Categories: Health Information, Implementation Update

Posted on October 11, 2012

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.

Update: Data Collection Standards Under the Essential Health Benefits Final Rule

Categories: Health Information, Implementation Update

Posted on September 5, 2012

By Nancy Lopez Background On July 20, 2012, the United States Department of Health and Human Services (HHS) published a final rule[1] establishing data collection standards for health insurance issuers as part of HHS’s implementation of certain aspects of the Patient Protection and Affordable Care Act’s (ACA) essential health benefit provisions.[2] As discussed in an [...]

Administrative Simplification: Adoption of Operating Rules for Health Plan Eligibility and Health Care Claim Status Transactions

Categories: Health Care Quality and Delivery System Reform, Health Information, Health Insurance, Implementation Update

Posted on April 13, 2012

On July 8, 2011 the Secretary of the Department of Health and Human Services (HHS) issued an Interim Final Rule with Comment Period (IFR) regarding the operating rules for two types of HIPAA transactions: eligibility for a health plan and health care claim status. The rules are in response to Section 1104 of the Affordable Care Act (ACA), which directed the Secretary to adopt certain operating rules for transactions to enable electronic health information exchange and create greater uniformity in the transmission of health information. The ACA defines operating rules as...

Release of Medicare Data for Performance Measurement

Categories: Centers for Medicare & Medicaid Services, Health Care Quality and Delivery System Reform, Health Information, Implementation Update, Medicare

Posted on July 6, 2011

Health policy experts and lawmakers believe that measuring and publicly reporting information about the performance of physicians, hospitals, and other health care providers is critical to improving health care quality and controlling costs. Advancing health information access and transparency is a goal of the Patient Protection and Affordable Care Act (ACA), which includes a number of provisions to incentivize quality measurement and reporting and to enable more informed consumer decision-making.

Health Information Privacy and Security

Categories: Health Information

Posted on December 13, 2010

The health reform law makes no major revisions to legislation enacted in 2009 to strengthen the standards for health information privacy and security. However, because protection of individuals’ interests in the privacy and security of their health information is foundational to the implementation of many aspects of health reform, this entry summarizes the key provisions of the 2009 law and describes the process of implementation as well as activities to date.

Health Information Technology – Adoption Incentives

Categories: Health Care Quality and Delivery System Reform, Health Information

Posted on May 3, 2010

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.