Any time there’s a change in administration, there are going be changes on the healthcare policy front; that’s to be expected. What isn’t expected is having to contend with things like the Affordable Care Act facing a possible repeal, the HHS Secretary stepping down amidst a travel budget scandal, and one of the worst hurricane seasons on record. It’s certainly not the easiest time to try to get the ear of politicians, but nevertheless, CHIME’s Policy Team persists in their quest to advocate for cybersecurity legislation, make the case for telehealth funding, and get answers to the data blocking debate.
At the recent CHIME Fall Forum, we sat down with Leslie Krigstein, VP of Congressional Affairs, and Mari Savickis, VP of Federal Affairs, to discuss the biggest priorities on their plate, the key challenges they face in pushing legislation forward, and what they believe will be the key priorities for CIOs and other health IT leaders in 2018.
Gamble: Hi Leslie and Mari, thanks so much, as always, for taking some time to speak with us. There’s always so much happening on the policy front. Let’s start by talking about National Health IT Week. What were some of the key takeaways from that? What really stood out to you?
Krigstein: I think it was a successful week. Because it overlapped with Cybersecurity Awareness Month, we were able to take advantage of our experts and their expertise. We were able to have a briefing and meet with Congressional staff and agency staff and continue to raise the profile of cybersecurity and talk about it as a patient safety issue, and talk about some of the opportunities and challenges that the Healthcare Cybersecurity Task Force report presented us with.
And so although it was a stark reminder of the state of the industry that keeps us up at night with all the things we need to do, it also gives a list of action items for all the stakeholders. We were able to talk about, what coming from that report, what Congress can do with it.
We also heard from the members in terms of how they’re operationalizing and how they’re looking to be more proactive. That was really a key focus, and I think we were successful. There’s definitely more to be done — this is the beginning of the conversation about how to operationalize that and continue to move some of the cybersecurity policies forward.
There was a bill announced [last week] that acts on some of the HHS-focused imperatives of the Task Force report. So we’re definitely seeing progress. There was also a medical device bill introduced as well, so we’re starting to see interest bubble up. I think we were successful in stirring the pot a little and generating some discussions.
Gamble: I can imagine that with some of the largescale breaches that have occurred, there’s certainly an awareness among Congress regarding the importance of cybersecurity. But it sounds like it’s a point that still needs to be driven home, particularly in healthcare.
Krigstein: Absolutely. We had a lot of questions like, “What do you do in breaches?” and “How are they reported?” So it definitely opens eyes and ears, especially in the wake of WannaCry and Petya.
Gamble: In terms of the Task Force report, it seemed to take a broad view of cybersecurity in healthcare and say, ‘here’s the state of things, and here’s what we want to see happen.’ What are the next steps?
Krigstein: There are definitely some short-term recommendations that CHIME and AEHIS are working on with our partners. There were specific recommendations for HHS; some of those HHS will address in the near-term, and some may take years to carry out. And there were some for Congress, which are in draft form now. The recommendations ran the gamut — and there were more than 100 of them, and it’s a lot to digest. So I’d say it really is a work in progress at this point. It’s a long road.
It’s important to remember that it targeted the whole sector, and there’s a lot to do under each of those segments.
Gamble: Another issue we’re hearing a lot about is data blocking. ONC is still working to define what that means, and I can imagine it’s a source of frustration for CIOs and other leaders. How is CHIME approaching that issue?
Krigstein: It’s interesting; during the 21st Century Cures implementation hearing yesterday, there was some back-and-forth between Senator Lamar Alexander and Jon White from ONC about why we aren’t getting more information about the timelines. Clearly there’s congressional interest, and providers are very interested in the guidance that CMS recently put out reiterating what they had already said about attestations. There are questions about why information blocking hasn’t been defined, and the agency pushed back and said they were first tasked with defining what information blocking isn’t, and so there are hiccups and hurdles we have to work through.
Savickis: I think we’re inching in that direction, but we haven’t yet seen that tidal wave. There’s also a lot of anticipation of regulatory relief, but when you think about it, this is a year of transition. The first big rule that came out of CMS was a big marker in the sand, which was the final rule that updates Medicare payment and policies for discharge. That was in April, which was just a few months after the inauguration. But they have been dropping bird crumbs along the way with requests for information about how to reduce the burden on clinicians.
So we’re migrating in that direction, and they’ve put out some guidance on data blocking. But from a regulatory relief standpoint, I would’ve expected more. The only thing in the statute is the first attestation statement; I wouldn’t have expected them to maintain the second and the third, which we thing goes beyond the statutory authority, especially since it’s an ‘I’ll know it when I see it’ scenario. So I thought that was a little disappointing.
But we’ve had many positive developments, like Meaningful Measures, which will improve quality measurement. And we’ll be diving further into what exactly this means for providers. On the surface, we were pleased to hear that they were going to focus more on outcomes than process, but of course if it’s coupled with an implementation that requires a substantial upgrade, then we need to take a harder look at it. And so I think we’re moving in the right direction, just not at the pace that providers want to see. Hopefully we’ll turn a corner in 2018.
Krigstein: Even with issues like information blocking and some of the key interoperability pieces, hearing that the new Health IT Advisory Committee won’t get started until the winter of 2018 is frustrating. There are so many things coming out of the 21st Century Cures Act that have to shake out. So I think it’s going to be a very exciting time.
Savickis: There’s some nervousness around the Office of Inspector General in terms of what they’re doing. They’re in information-gathering mode, and they’ve been relatively quiet about what they’re plans are. That will be a big bell-weather in terms of how the industry is regulated. So we’re anxious to see what they say. It could be painful, or it could be a relief.
Krigstein: The OIG representative actually mentioned that they’re looking at other authorities beyond what they were granted in 21st Century Cures to enforce information blocking. The committee members were happy to hear that, but it definitely raised some hairs on the back of my neck. What does that mean for all of us? That’s going to be a huge topic for our membership and for the whole provider community.
Gamble: Right. And on top of everything else, Secretary Price stepped down at the end of September. Has this added another obstacle for you in just going about the daily tasks on the Hill?
Savickis: To be honest, we were already floating around just with everything that’s been going on. We’ve had the transition with the new administration, and the Affordable Care Act has been a source of activity that has taken some of the oxygen out of the room. But I don’t think it has really affected us — at least not as much as the ACA repeal talks. It seems to come and go, and when it goes, we can go back to focusing on things like when the Health IT Advisory Committee will be announced.
Krigstein: The other thing is that getting someone confirmed is going to be really difficult. There are so many politically charged pieces to this that have to be dealt with if you’re going to go through a confirmation hearing.
Savickis: It’s slowing us down. How can you solve interoperability when you have some other really big pieces of healthcare that are taking up so much energy and attention? Even on the Hill, people only have so much bandwidth. But it doesn’t stop us from forging ahead. Cybersecurity, as Leslie noted, is a huge issue that seems to have been inoculated from this, which was probably helped by the Petya and WannaCry incidents this past summer.
We’ve had two acting secretaries since Dr. Price left, and of course the hurricanes that hit. That takes up a lot of energy and resources when you’re dealing with emergency management. There’s been a lot that’s happened outside the lane of health IT.
Gamble: When we talked at last year’s Fall Forum, one of the top priorities CHIME members had identified for 2017 was telehealth, which is an area that has seen its share of starts and stops. What are you seeing on this front?
Savickis: There’s been a lot of head-banging. There have been stakeholders who are really engaged, and some associations that have taken this under their wing to help demonstrate cost savings. We’ve been very supportive of those efforts, but it seems like they keep knocking heads, and it’s really chipping away process.
Krigstein: There’s a bill that passed the senate that had telehealth provisions, a lot of folks are taking it on a chunks, like starting with a specific disease states or uses cases. I think people are thinking creatively and looking at ways to get around some of the cost concerns that the Congressional Budget Office has.
I think the rule proposed by the VA to override state licensing laws will really help to expand telehealth services. If some of these agencies that aren’t under the same set of constraints and have a little bit more flexibility are able to demonstrate success with expanded use of telehealth, that could really open some doors.
It’s been very positive to see Seema Verma talk about telehealth in her confirmation hearing, and President Trump showcase the VA model. There’s a recognition that it has a lot of potential to improve care and lower costs. We’re seeing more progress now than we ever have in this area — but there’s still a long way to go.
In the report CHIME co-authored with KLAS found that reimbursement is still a significant hurdle. And so the more we can illustrate that and show positive results, better chance it has to move forward. In that study, they found that patients are accepting of technology and they like the expanded access. So I think there’s a more comprehensive narrative that all stakeholders are developing — whether it’s providers, associations, or CIOs — and hopefully we can weave a narrative together and make it a reality.
There’s a lot of optimism. I think we’ll continue to see progress and continue to see some bills passed.
Gamble: As far as 2018, what else do you expect to be on the forefront of CIOs’ minds?
Krigstein: One thing we definitely expect to see as a priority is digital health. It’s been a big theme at this Forum, in terms of what it means and what CIOs need to do. And actually, in a presentation, David Chou [CIO, Children’s Mercy Hospital] identified the key components as: being cloud-based, leveraging analytics, incorporating social data, and having a mobile strategy. That’s just one definition, so it’s going to be really interesting to see how this continues to shake out.
Gamble: Definitely. Well, thank you so much for taking some time to update us on everything you’re working on. I’m sure we’ll be in touch again soon.