Republicans attack new HIT ‘meaningful use’ rules

House GOP leaders this week went after new White House rules designed to encourage healthcare providers to use new medical technologies, arguing that they aren’t strict enough to promote quick adoption of the equipment.

“Much less is expected of healthcare providers receiving subsidies than what [the Centers for Medicare and Medicaid Services (CMS)] had initially proposed,” Rep. Wally Herger (Calif.), senior Republican on the Ways and Means Health Subcommittee, said Tuesday during a hearing on the so-called “meaningful-use” rules.

“The final regulations … represent a missed opportunity to improve patient care and reduce waste,” Herger said.

Administration officials disagreed. Appearing before the panel, David Blumenthal, national health information technology (HIT) coordinator at the Department of Health and Human Services (HHS), said the new guidelines “strike a balance” between adopting electronic health records quickly “and recognizing the challenges that adoption will pose to healthcare providers.” 

“Our approach to meaningful use must be both ambitious and achievable,” Blumenthal said. “The speed of ascent must be calibrated to reflect both the capacities of providers who face a multitude of real-world challenges and the maturity of the technology itself.”

The debate swirls around HHS’s final rules governing providers as they adopt mandated HIT systems, including e-prescribing and electronic health records. To ensure that providers are actually using those tools to improve healthcare services, Congress required the agency to establish benchmarks for providers hoping to take advantage of federal incentive payments for HIT adoption.

Bowing to provider complaints that benchmarks proposed in December were too stringent, HHS scaled back the requirements in its final rule.

For instance, while the proposed rule would have required doctors to e-prescribe 75 percent of their drug orders to meet incentive requirements, the final rule lowered that threshold to 40 percent. 

Also, CMS’s proposed rule had required physicians to meet 25 “meaningful use” objectives, with hospitals asked to meet 23 markers. The final rule splits those objectives into a group of core measures — 15 for doctors and 14 for hospitals — and offers a menu of 10 additional measures, from which providers can choose five to report.

Under that incentive system, doctors are eligible for up to $44,000 through Medicare and $63,750 through Medicaid. 

Herger, though, says the new requirements are too lenient. Among the optional items that providers can choose not to report, Herger noted, are harmful drug interactions and the results for clinical lab tests. 

“So each of the practices that experts have told this subcommittee are vital to improving patient safety and eliminating waste, are optional,” Herger said. The lesser requirements, he warned, could lead to “a lower standard and lower compliance rates.”

Democrats, though, have a different take. Rep. Pete Stark (D-Calif.), chairman of the health subpanel, said HHS “took a responsible position in the final rule.” 

“The standards are aggressive, but set realistic goals,” Stark said in his opening remarks.

Many provider groups have applauded HHS’s move to ease the requirements for incentive payments. But those same groups are also criticizing the agency’s decision to exclude individual hospitals operating under multi-campus university systems. 

The Premier healthcare alliance, a national provider network, warned Tuesday that a failure to change the rules to include those facilities “could financially handicap their ability to implement EHRs in a timely manner.”