CHIME: Mostashari Urges Focus on MU Hardship Exemptions

At the College of Healthcare Information Management Executives, former ONC chief Farzad Mostashari stopped short of supporting alterations to the 2014 final rules or deadlines, but suggested that providers determine whether hardship exemptions can postpone Meaningful Use Stage 2 penalties.

In his first appearance since leaving his post earlier this month as National Coordinator for Health IT at HHS, Farzad Mostashari has suggested that providers find out if hardship exemptions can postpone Meaningful Use Stage 2 penalties.

"CMS could clarify what constitutes a hardship exemption. You wouldn't get the incentive payment, but you wouldn't get the penalty, one percent of Medicare payment cut either," said Mostashari, speaking at the annual conference of the College of Healthcare Information Management Executives (CHIME) in Scottsdale, Arizona.

The final rule governing Meaningful Use 2014, including Stage 2 requirements for providers entering their third year of attestation, specifies compliance by October 1, 2014 for a 90-day reporting period during that year. The final rule does allow for delayed attestations due to hardship, but CMS clarification "could provide additional flexibility… so that's where I would advise CHIME to look."

CHIME has strongly supported the current timetable for Meaningful Use 2014, but at the same time has asked ONC to provide additional flexibility by delaying the penalty phase.

Mostashari stopped short of supporting alterations to the 2014 final rules or deadlines laid out in the final rules published in 2012.

"There's no legal way to change a final rule without doing a pretty involved process," Mostashari told the CHIME audience. "It takes about nine to 12 months of proposing the new rule, getting that cleared through OMB, getting public comment on it, and all the stuff you guys have been through with Stage 1 and Stage 2. It would be total chaos."

Delaying implementation of the Meaningful Use 2014 and Stage 2 rules would also negatively impact programs such as the IQR, PQRS, and ACO initiatives at CMS. "We've worked really hard to align them, and if you take this out, that alignment falls apart," Mostashari said.

"You can't then use the Meaningful Use quality reporting to count towards PQRS and IQR and ACO… I think folks should assume that the timelines stick."

On Oct. 3, Mostashari accepted a position as visiting fellow and vice president and director of economic studies at the Engelberg Center for Health Care Reform at The Brookings Institution, a Washington D.C.-based think tank.

Before Mostashari left ONC, the office announced that effective October 4, the management team would be led by Jacob Reider who will serve as acting national coordinator, Lisa Lewis would serve as acting principal deputy, and Joy Pritts would continue to serve as chief privacy officer.

Reider was scheduled to speak at the CHIME conference, but the October 1 government shutdown and strict government rules led to that presentation being cancelled. Reider was even prohibited from traveling at his own expense to the event, CHIME officials said.

Mostashari took the occasion to outline a series of concerns he has about the Meaningful Use program moving forward:

On Business Practice Challenges
"We may have the right incentives and we may have the right information, but too many people, [and] too many institutions don't know how to do this new form of delivery. We can talk about population health management all day long. We can even buy population health management software. But changing, flipping practice, flipping the hospital, changing so that everything doesn't have to take place in an eight-minute doctor's visit that is what we could get reimbursed under fee-for-service, creating standing orders and protocols, that's a cultural challenge. That's not an IT challenge. That's a business practice challenge."

On Product Usability
"I do worry about the usability of the products. Not that the usability isn't getting better. I think it is getting better. But the expectations are getting better even faster. Maybe new hardware forms are going to actually help with that. But this was one where I didn't think…there was a clear government role as much as there was a market role, and I don't know if the market is incentivizing usability as much as maybe it could."

On Time Constraints
"The other worry is of course time, the limits of time, and all of you are under incredible pressures this year. ICD-10, Meaningful Use Stage 2, and other transformation, ACO enablement, population health management. "[What] I don't think is going to happen is the pace of change slackening off."

On Collaboration
"How much of your time is spent doing things that you think other hospitals have already done? A lot of the time of our committees is figuring out order sets. That development time is unnecessary. Everyone rediscovering that same thing is not necessary… helping others is the only way we can get through this. These are fantastic opportunities for us to come together and find those ways of information sharing and those relationships that will sustain that information sharing once you leave here. But I wonder if there's a way to make that even more systematic."

On Vendors
"Vendor user groups are good. Vendor-provided platforms where you can share modules or content, that's good. It just doesn't feel like we're having enough of that happening to get us collectively through this next difficult period."

On Innovation
"I'm seeing a problem in terms of the matching up between the supply and the demand of new products. I'm seeing a lot of people coming up with ideas, not necessarily businesses yet, who are pitching furiously. They need some partners. They need some clinical understanding. They need a place to try out their new innovations. Someone said to me, it was the vice president for innovation at Dignity, said I've had a thousand people come to me with readmission algorithms… I don't know that I need a thousand of them, but it would be nice to know which one's best. It's really hard to evaluate which products, which vendors, those additional vendors you want to work with. And it's really hard for them without making that connection. So again, a lot of what we're going to need is going to be about matching up with each other, matching up the learning, matching up with innovation…a lot of it isn't government policy."