American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Health Information Technology

The American College of Surgeons (ACS) has developed a set of principles on how to best improve care of the surgical patient through leveraging clinical information digitally available in the age of electronic health records (EHRs). Broadly, the ACS believes there is a need for governance of universal data and technology platform standards to create a clinical data ecosystem that holds the best structure for cloud-based, secure, open-access sharing and interoperability.

Meaningful Use

Medicare meaningful use (MU) requirements were first introduced to physicians in 2011 to promote the adoption of EHR systems. MU policies were a product of the Health Information Technology for Economic and Clinical Health (HITECH) Act, a key component of the American Recovery and Reinvestment Act of 2009. The HITECH Act charged the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology with the responsibility of developing a universal infrastructure that would facilitate the secure exchange of digital information. It also authorized the Centers for Medicare & Medicaid Services (CMS) to create the Medicare and Medicaid EHR Incentive Programs, which established financial incentives for physicians who demonstrate MU of an EHR system.

The College continues to educate Members of Congress on the shortcomings of the MU program. The ACS advocated for a delay in the introduction of Stage 3 MU because only 19% of health care professionals and 48% of hospitals had successfully met Stage 2 requirements by the end of 2015. Congress has been receptive to ACS’ concerns and has taken steps to alleviate some of these issues. For example, the Senate Committee on Health, Education, Labor, and Pensions (HELP) held six hearings in 2015 on related topics. On July 23, 2015, the ACS submitted testimony, “Achieving the Promise of Health Information Technology: Information Blocking and Potential Solutions.” This document outlined ACS’ priorities for meaningful use of HIT.

The ACS has also sent letters of support and gained additional cosponsors on several pieces of related legislation. The Further Flexibility in HIT Reporting and Advancing Interoperability Act (Flex IT 2 Act, H.R. 3309) was introduced July 29, 2015, by Rep. Renee Ellmers (R-NC). This proposed legislation would delay MU Stage 3 implementation until at least 2017, or when the Merit-Based Incentive Payment System final regulations have been determined. The act would also expand the MU program’s current hardship exemptions, including allowing eligible professionals who are at or near retirement age to be exempt from MU reporting, and would adjust the reporting requirements to allow providers to choose any three-month measurement period. The ACS sent a letter of support for H.R. 3309 legislation on September 8, 2015, and is actively requesting cosponsorship.

S. 2141, the Transparent Ratings on Usability and Security to Transform Information Technology Act of 2015 (TRUST IT), was introduced by Senators Bill Cassidy (R-LA) and Sheldon Whitehouse (D-RI) on October 6, 2015. This bill encourages fairness and transparency in the process of choosing vendors for EHR systems. Under this legislation, HIT vendors must attest that they do not engage in information-blocking activities, and they can be fined if they are found to do so. Furthermore, an HIT Rating Program of one , two, or three stars was established, and fines collected from noncompliant vendors will be redirected to provide financial assistance for “holding harmless” those providers who use a system that loses certification.

Additionally, Reps. Ellmers, Tom Price, MD, FACS (R-GA), and David Scott (D-GA) circulated a congressional sign-on letter asking U.S. HHS Secretary Sylvia Burwell to delay the Final Rule on Stage 3 MU requirements. As a result of the ACS grassroots and advocacy efforts encouraging Members of Congress to sign-on, this letter received 116 bipartisan signatories. The letter from Ellmers, Price, and Scott was sent to Secretary Burwell on September 28, 2015. HELP Chairman Lamar Alexander (R-TN) and Senator John Thune (R-SD) sent a similar letter to Secretary Burwell asking that MU Stage 3 requirements be delayed until at least January 1, 2017. Despite these efforts, however, the final rule for Stage 3 was still released on October 16, 2015, maintaining the 2016 release timeline.

CMS has required providers to attest that they met the requirements for MU Stage 2 for a period of 90 consecutive days during CY 2015 in order to avoid a penalty. However, CMS did not publish the Modifications Rule, which altered and added to the requirements, until after October 1, 2015. As a result, by the time providers were informed of these modified requirements, fewer than the 90 required days remained in the calendar year. Given the short timeframe and the large number of anticipated requests for hardship exemptions, Rep. Price introduced H.R. 3940, the Meaningful Use Hardship Relief Act of 2015, on November 5. This legislation would have amended the MU statute to provide a blanket hardship exception for the 2015 MU Stage 2 reporting period.

The intent of H.R. 3940 was rolled into a legislative vehicle on the last few days of Congress in 2015. The Patient Access and Medicare Protection Act (S. 2425), sponsored by Senators Rob Portman (R-OH) and Robert Casey (D-PA), was signed into law on December 28, 2015. This legislation will allow CMS to approve submitted hardship exception applications in a “batch” until July 15, 2016. By processing the submissions in this manner, those applying will receive a blanket hardship exception. It is important to note, while all applications received prior to March 15 will be approved, surgeons still must apply for the exception. Applications for the hardship exception are now available. An approved hardship exception will exempt Fellows from the payment adjustment in 2017.

MACRA

The Medicare Access and CHIP Reauthorization Act (MACRA) consolidated three existing programs into its Merit-Based Incentive Payment System (MIPS):

  • Physician Quality Reporting System (PQRS)
  • Value‐Based Modifier (VBM), which adjusts payment based on quality and resource use
  • Meaningful Use (MU) of Electronic Health Records (EHR)

The MIPS program will assess the performance of eligible professionals in four performance categories:

  • Quality
  • Resource use
  • MU of EHRs
  • Clinical practice improvement activities

The penalties associated with the current programs are sunset at the end of 2017, including the 2 percent penalty for failure to report PQRS quality measures and the 3 percent penalty (increasing to 5 percent in 2019) for failure to meet EHR MU requirements.

Contact: Mark Lukaszewski