While healthcare reform legislation may be just a month old, attendees of the American Hospital Association's annual membership meeting in Washington, DC, on Monday were told that hospitals are facing major challenges that need to be addressed right now to ensure quality care delivery will continue.
In earlier times, the mantra of healthcare leaders was "do more with less," said AHA President and CEO Rich Umbdenstock. But now there's a new twist: "That's changing to 'do better with less.'" This means that hospitals need to move to the forefront now to improve patient care quality, safety and reliability; construct new integrative models of care; and stop medical mistakes.
"We have to seize this opportunity and ensure hospitals are natural leaders at this time of great challenge and transformation," Umbdenstock said. But to get there, hospitals will require help at the federal level. And, according to two House members, Congress is listening and ready to assist.
One of the major areas of concern has been how hospitals can become "meaningful users" of electronic health records and adopters of health information technology under current federal proposals.
"We share the concerns that have been articulated by [the AHA] that the [Centers for Medicare and Medicaid Services] rule tries to push things too far too fast," said Rep. Chris Van Hollen (D-MD), who is chair of the Democratic Congressional Campaign Committee and who played a visible role in guiding healthcare reform through the House as assistant to House Speaker Nancy Pelosi (D CA).
"I think you have made the case very well that the short timetable will result in a disallocation of resources," Van Hollen told the AHA audience. "There will be many hospitals that [we are] assuming can't make it. Since the idea is to encourage hospitals and other providers to move in this direction, it doesn't make sense to create a target that nobody can meet."
Rep. Michael Burgess, MD (R-TX), a member of the House Energy and Commerce Committee and chair of the Congressional Health Care Caucus, was one of the legislators instrumental in sending out a letter (signed by 249 House members) to the acting CMS chief last month encouraging the agency to modify its definition for hospitals to become meaningful users of EHRs.
He told the hospital leaders that the "all-or-nothing approach that hospitals" adopt 23 separate EHR objectives has only been accomplished so far by a few hospitals. "The rule, in fact, should be altered--recognizing a practical staged approach to EHR adoption and rewarding the efforts already underway in various hospitals."
Burgess noted that the letter urged CMS to changed transition time from 2015 to 2017 for Medicare payment penalties incurred by non-meaningful users of EHRs. He also said the letter encouraged CMS to drop "non-clinical objectives" such as electronic insurance verification and claims submissions that are not related to patient care.
Van Hollen said definitions in the healthcare reform legislation will have to be revisited such as what are "hospital readmissions" for which Medicare will cease to pay. "The key is to figure out a smart way to distinguish between necessary and unnecessary readmissions. This is an area where we're probably going to have to work with you to refine the statute as we move forward," he said.
While the House voted on a temporary fix this month (through May 31) to stop the physician payment sustainable growth rate cut, a long-term fix is needed, Van Hollen said. "This is no way to be conducting a health payment system," he said. If a permanent fix cannot be obtain (which was in the House bill passed last year), "at the very least we hope to enact a five-year fix, which would certainly be better than the month-to-month and year-to-year approach."
The doc fix extension package did have some good news for hospitals, Burgess added. It included changes proposed in some of the provisions in the CMS EHR letter, such as including definitions of hospital-based physicians. Previously under the rule, physicians practicing in outpatient centers and clinics were excluded from being eligible for the EHR incentive payments.
Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.