Proposed SGR Bill Could Change Physician Reimbursement, Interoperability

Mar 23, 2015 | Uncategorized

Proposed SGR Bill Could Change Physician Reimbursement, InteroperabilityThe proposed permanent fix to the sustainable growth rate (SGR) formula may bring big changes to interoperability.nnRep. Michael Burgess (R-Tex.) has introduced H.R. 1470 to repeal and replace the Sustainable Growth Rate formula that Medicare uses to pay physicians. The bill as introduced does not include language to change policy on the ICD-10 compliance date or the two-midnight rule pertaining to hospital payments. However, it does lay out a program to have “widespread” electronic health records interoperability in 2019, with the threat that certified EHRs not supporting interoperability could be decertified.nn“As a consequence of a significant Federal investment in the implementation of health information technology through the Medicare and Medicaid EHR incentive programs, Congress declares it a national objective to achieve widespread exchange of health information through interoperable EHR technology nationwide by December, 31, 2018,” according to the 158-page bill, available here.nnBurgess’ legislation, which won’t be the only SGR bill being considered in the House and Senate, defines widespread interoperability as meaning “interoperability between certified EHR systems employed by meaningful EHR users under the Medicare and Medicaid EHR incentive programs and other clinicians and healthcare providers on a nationwide basis.” The bill includes incentives, such as streamlined quality reporting, for providers who are not eligible for the meaningful use program to use certified EHRs.nnIn the legislation, interoperability is defined as “the ability of two or more health information systems or components to exchange clinical and other information and to use the information that has been exchanged using common standards as to provide access to longitudinal information for health care providers in order to facilitate coordinated care and improved patient outcomes.”nnicd10_EHR-resized-600Further, the Department of Health and Human Services would be tasked to establish metrics to identify the extent to which interoperability objectives are being achieved, and to submit a report to Congress identifying objectives not being met along with recommendations to get them back on track. These recommended actions could include: “to adjust payments for not being meaningful EHR users under the Medicare EHR incentive programs;” and “criteria for decertifying certified EHR technology products.”nnThe legislation also calls for EHR users to demonstrate, possibly through attestation, that they have not “knowingly and willfully taken action (such as to disable functionality) to limit or restrict the compatibility or interoperability of the certified EHR technology.”nnThis article originally posted on HealthDataManagement.comnn


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