HIMSS: Providers Awaiting SGR Repeal Seek Interoperability

Following the House's recent decision to pass the "doc-fix" bill to permanently repeal the sustainable growth rate (SGR) formula by a vote of 392 to 37, the healthcare industry waits upon the Senate's next move.  Physicians can avoid a twenty-one percent cut in Medicare reimbursement and will receive a 0.5 percent pay increase annually for five years if the Senate passes the legislation next week following a two-week hiatus.

Tom Leary, Vice President of Government Relations at Healthcare Information and Management Systems Society (HIMSS), spoke with RevCycleIntelligence.com this week to offer more insight into the organization’s overall viewpoint regarding the SGR repeal.

“From a HIMSS perspective,” says Leary, “the SGR repeal is important in that it further aligns the quality of reporting programs and it makes sure that we’re all working together to meet the interoperability that’s envisioned towards getting a nationwide health information network so that we do have better access, better quality, and we can control or decrease the cost of care.”

Leary says a lack of action from the Senate means some individuals or organizations may interpret this as the sky falling down.

“There is strong interest in getting this done and getting this done right so we don’t have to keep addressing it every six to twelve months,” Leary states. “Seventeen fixes over the years, some of them being a three month fix, a six-month fix, or eighteen month fix, create a level of uncertainty and anxiety within the community.”

The long term repeal legislation passed by the House fosters an alleviation of this anxiety, says Leary.

“On the House side, it’s a well-crafted solution that a lot of people can get behind. Ultimately, the anxiety will go away when they pass the SGR fix,” Leary adds.

Leary says the ability of the Centers for Medicare and Medicaid Services (CMS) to hold electronic submissions for payment for up to two weeks by providers and paper-based for up to thirty days before processing means there will not be a twenty-one percent decrease on reimbursement for providers at the beginning of April.

“There is some wiggle room while Congress settles the differences and gets the legislation passed,” says Leary.

Leary says the number one issue providers face is administering quality care as they continue to engage with their patients.

“Providing the legislation passes, the long term implication – particularly for patients – is that providers will be reimbursed and with the way the legislation is crafted, there will be more coordination amongst quality programs,” Leary explains. Ultimately, that’s intended to improve access and improve the quality of care the patient receives. The long-term fix is supposed to benefit patients.”

Leary says the healthcare industry needs to actively head in the direction of the merit-based incentive payment system (MIPS).

“It ultimately comes down to having the quality data available and being able to report that quality data so the provider can see where they’ve improved and continue down paths where they can better serve their patients,” explains Leary.

Patients who can make better informed decisions as active participants in their healthcare is an additionally needed step towards the establishment of a provider-patient partnership and enhanced care delivery, adds Leary.

Leary says HIMSS has been pushing for changes to the quality reporting process throughout the past several years so CMS isn’t just using standards that are untested.

“From HIMSS’ perspective,” states Leary, “it comes down to the provider’s ability to meet the value based payment requirements, making sure we as a community have systems capable of gathering the right quality data and reporting that quality data based on standards that are recognized by CMS and other insurers that are recognized and field tested.”

HIMSS had offered suggestions that CMS to utilize an incubator or process for testing standards in a nearly live environment to be then followed up with testing in a live environment, says Leary. Such suggestions would mean providers can gather the information reported in the way it’s been envisioned by the government so negative impacts on quality scores and Medicare and Medicaid reimbursement are minimalized, says Leary.

“Ultimately, we want to reach a point where the government, the associations, and the providers and the patients have full confidence that the information gathering can occur and then the reporting can occur so that we do see that improved access, improved quality and theoretically the decrease in costs of care,” says Leary.

“It’s incumbent upon us as a healthcare IT community to continue to educate the government on which standards are most mature and what other standards are in line to being mature enough to be utilized,” Leary maintains.

A further ICD-10 delay being ruled out of order is further indication of the House’s maintained interest in continuing to move forward on the October 1 start date of this year, says Leary.

“HIMSS is an organization that’s been very focused on making sure providers and hospitals and vendors and consultants all are prepared for the transition into ICD-10,” Leary explains.

As providers interact with vendors to work together and make sure software is updated and the proper technological changes are implemented so gaps in the ability to utilize ICD-10 are minimized, Leary says there will be a monumental focus on ICD-10 preparation over the next several months.

“The government will continue to debate whether or not the October 1 start date will occur,” says Leary. “Ultimately when the date does come around, having those tools and testing systems against other systems is really what we’re making sure occurs so that on day one, people aren’t caught flat footed.”

The road ahead will not necessarily be smooth, says Leary.

"As the healthcare industry awaits the Senate’s decision to pass the legislation in a timely fashion, providers will struggle to provide care until something has been addressed by the second week of April so CMS can properly reimburse providers for care that’s been delivered.”

Leary says reaching the objective of interoperability will give providers and patients the confidence that quality data that’s being gathered and reported so providers will in turn be reimbursed. This will then enable better quality care for the patient, says Leary.

“If the patient is receiving the best quality of care, they’re not in danger of losing out on a provider who’s so frustrated with the program that they walk away,” says Leary. “For the long term, that’s what we really need to all work towards, making sure we continue to tweak the system so it’s more efficient and more effective for the patient and the provider.”

Revenue cycle will continue to be impacted with new legislation from the House side, says Leary.

“In terms of regulating health IT, whether or not we regulate to the point where we stifle innovations and stifle the balance of engaging patients and engaging providers, that’s going to be on people’s minds for spring and summer,” confirms Leary.

Stay tuned for additional interviews on RevCycleIntelligence.com about SGR repeal as this month’s coverage continues.