In the world of public policy, there’s never a dull moment. As soon as one initiative gets put on the backburner, another — or, more realistically, a cluster of others — moves quickly to the front. It’s particularly true in health IT, where federal mandates have dominated the conversation and change has become the new normal.
But although it often takes a gargantuan effort to achieve even a small victory, it’s all worth it for Mari Savickis and Leslie Krigstein, who head up CHIME’s advocacy team. And in fact, the “elation” they felt after CMS announced its decision to delay the 2015 CEHRT requirements quickly gave way to a renewed focus on other key priorities, such as cybersecurity and patient data matching.
Recently, healthsystemCIO.com spoke with Savickis, VP of Federal Affairs, and Krigstein, who heads up Congressional Affairs, about their feelings on CMS’ decision — and what it took to move the needle; how CHIME is “diving deeper” to create a cybersecurity framework; how they’ve dealt with the adjustment period that comes with a new administration; and what they enjoy most about their work.
- Working with the new administration
- HHS Secretary Price — “We believe we have an ally.”
- Reducing the regulatory burden to make IT “as seamless as possible.”
- Pacing change: “You might have to take a few bites.”
- Best part of being with CHIME
- Drinking from the cybersecurity firehose
That’s something they’ve really honed in on, and of course we support it. Our members work with clinicians every day, and they’re constantly hearing that certain tools are cumbersome or aren’t working as seamlessly as they could be, and that’s a problem.
We want to see change, but sometimes it’s like trying to swallow a whole apple at once. It’s too much, too fast. And so you have to take a few bites, which is what we’re pushing for.
That’s the best part of my job, because that’s where the rubber meets the road. It’s one thing for me to tell policymakers or HHS or CMS, ‘here’s what CHIME thinks.’ It’s a whole other ball of wax when you have the members speak to CMS, or you’re using the member’s words.
I’ve never had the kind of access to members and been able to leverage their firsthand experience in a way that we are able to at CHIME.
Gamble: When I spoke with you both at HIMSS back in February, the new administration was just taking shape. Now that some time has passed, what has your experience been like as far as the conversations around health IT? Has it been similar to what you’ve experienced in the past?
Krigstein: There seemed to be an exodus of folks we worked with closely on the Hill who left to work on the administrative side. They’re staffing up on the policy side, which is unfortunately for CHIME because we never want to lose allies and advocates, but to have them go to the administration is positive. Now that we’ve had the chance to meet ONC’s new leadership and folks at CMS, we have a little more clarity.
But in terms of advocacy on the Hill, we haven’t done as much as we had in years past with things like certification, for example, because we were optimistic that Secretary Price would be helpful to us, as he has before in cases like this. I think his colleagues on the Hill shared the same mentality of, ‘We believe we have an ally. It’s just a matter of things shaking out and having time to influence it.’
As those bridges start to be rebuilt between the Hill and the agency, we’ll start to see what can be done and what needs take precedence. I think there will be some things in our world that require new legislation. There’s also the Ways and Means Committee’s Medicare Red Tape Relief Initiative that was announced a few weeks ago, where they very asked stakeholders to tell them what Congress needs to do in terms of legislative changes. However, they also let us know that they’re willing to speak with Administrator Verma and make recommendations. So I think you’re starting to see those channels reopen as folks are getting settled in their new role.
Gamble: Has that been your experience as well, Mari?
Savickis: It has. Things were definitely slow at the beginning of the year because there was like such a seismic shift in the administration. They’re still populating spots at HHS, but we’re much further along than we were in February. In our meetings with these folks, the thing they’re focused on most is regulatory relief. It’s an issue that’s rooted in the administration, and there are also folks on the Hill who are very intent on lightening the burden.
But the administration has put out many rules — the inpatient prospective payment system (IPPS), Physician Fee Schedule, and Quality Payment Program, to name a few — that have included a request for information regarding how CMS can reduce the regulatory burden on providers. We responded to one of those in April and we’re in the process of reviewing what we’ve learned since earlier this year and seeing what has changed, and we’ll be doing another deep dive into regulatory relief. That is something that is of widespread interest to the new administration. This is something we believe will carry forward in terms of how we can reduce the red tape and make life all around easier for providers, and we obviously support that. And so we’ve been commenting on that.
Those, of course, are CMS rules. ONC has told us many times that they’re very focused driving EHR usability. They want to make sure this is something that can materialize in a more substantial manner, because they’ve received so many complaints over the past few years about the burden on clinicians. And that will only continue with having HHS headed up by Dr. Price, who is a physician. He wants health IT to be as seamless as possible for doctors and other clinicians.
That’s something they’ve really honed in on, and of course we support it. Our members work with clinicians every day, and they’re constantly hearing that certain tools are cumbersome or aren’t working as seamlessly as they could be, and that’s a problem. Anything that can be done to reduce the burden is helpful. So we’ve heard quite a bit from the administration on that, and we expect that to continue. This is just the start.
Along those lines, President Trump actually released an executive order that discusses reducing regulatory burdens on businesses and the private sector. Each department is charged with naming a regulatory relief officer and identifying rules and policies that are considered an impediment to doing business. Healthcare obviously makes up a large portion of the US economy, and so we’re looking to HHS to see where they’re going to take action, and we’re giving them our ideas.
One thing we’re very happy with are the changes regarding the appropriate use of imaging requirements that were slated to go into effect January 1, 2018. There is, however, a proposal in the Physician Fee Schedule rule that would delay this one year, which we strongly endorse. We want to see change, but sometimes it’s like trying to swallow a whole apple at once. It’s too much, too fast. And so you have to take a few bites, which is what we’re pushing for.
Our folks need a little more time to digest this as they’re standing up 2015 CEHRT, preparing for MU Stage 3, and doing Appropriate Use—which is another bill; it’s not part of CEHRT. There’s just a lot going on. So from a regulatory relief standpoint, it was very helpful.
Gamble: And of course you’re still working in August.
Krigstein: Oh yes. We have comment letters and responses we’re working on. No rest for us on the policy side.
Gamble: I’d like to switch gears a little bit and talk about your career paths. Mari, you’ve been with CHIME for about two years?
Savickis: Yes, as of this month. Before that, I was with the AMA for almost 10 years.
Gamble: Okay. So when you reflect on your time so far, what would you say your enjoy most about your role with CHIME?
Savickis: That’s easy — talking to members, I love it. That’s the best part of my job, because that’s where the rubber meets the road. It’s one thing for me to tell policymakers or HHS or CMS, ‘here’s what CHIME thinks.’ It’s a whole other ball of wax when you have the members speak to CMS, or you’re using the member’s words. And it helps me understand how policies are really working out in the field.
I absolutely love talking to members. Frankly, they’re so experienced and seasoned that even on my best day, I have to speak with them in order to do my job better. Going back to what Leslie said earlier about certification and how we were able to move the needle, it was the granularity of the stories that came from the frontlines of how this is affecting them. That’s what makes all the difference.
Gamble: What do you think has surprised you most about your time here?
Savickis: I wouldn’t use the term ‘surprised,’ but I have learned a lot. There’s never a dull moment here, which I like, because I don’t like to be bored.
One thing that’s been a learning curve for me is cybersecurity. I didn’t cover it as much at my last job, so I’ve really become a student of cybersecurity. It’s an issue that I continue to dig into, and I’m learning so much, which I love. It challenges me, and I think it compliments my background in HIPAA privacy and security. But cyber is a whole other level. There’s a new set of acronyms and players, and so I’m still learning the ropes. It’s been that ‘drinking from the firehose’ experience, because it was identified in an annual survey of our members as the number one issue in terms of public policy concerns. And if it’s CHIME’s top issue, it’s my top issue. So I’ve been learning a lot about that.
Gamble: Very interesting. And Leslie, you said you’ve been in your role for about three years. What was it that made you interested in coming to CHIME?
Krigstein: I think it’s the critical role our members play in healthcare delivery. There absolutely is no question that technology is the future of healthcare, and so being able to advocate on behalf of the key decision makers as to how healthcare is going to evolve was a great opportunity. For me — and I think this is true for Mari as well — having worked for other organizations, I’ve never had the kind of access to members and been able to leverage their firsthand experience in a way that we are able to at CHIME.
Our members work so hard, and I think it becomes incumbent on us to work as hard as they do because they deserve it. They’re trying to do so much to help improve care in what is a heavily regulated, tumultuous industry, and they need as much help as they can get. That’s something that was really appealing to me — that I was able to have that level of interaction with executives that are key decision-makers in their organization, and in our industry.
Gamble: Right. That definitely sounds like a good reason. Well, I want to thank you both so much for taking the time to speak with us. There’s so much going on from an advocacy perspective, even in the summer, and we appreciate your insights. I hope to speak with you both again soon.
Savickis: Thanks for reaching out. We’re always happy to chat.