Connecting Michigan for Health 2013 http://mihin.org/

1. Current Health IT Public Policy Issues
Richard M. Hodge, MBA, MPA
Senior Director, Congressional Affairs
703-562-8847; rhodge@himss.org
June 6, 2013
1

2. Vice President
Government Relations
Tom Leary
Executive Director
Institute for
E-health Policy
Neal Neuberger
Executive
in Residence
Simeon Niles
National Health IT Week
Congressional Luncheon
Seminar Series
Internships/Student
Experiences
Senior Director
Congressional Affairs
Rich Hodge
Director
Government Services
Stephanie Jamison
Senior Director
Federal Affairs
Vacant
Manager
Federal Affairs
Katie Boyer
Coordinator
Government Relations
Evan Yeckley
Manager
Public Policy
Kathie Westpheling
Senior Manager
Public Policy
Communications
Elinore Boeke
Manager
Public Policy
Initiatives
Arnol Simmons
2
HIMSS Government
Relations Team
Coordinator
Government Relations
Leslie Irvine

3. HIMSS does not Lobby
 Advocacy is the organization of information into
arguments used to persuade an audience towards
some attitude and predisposition to action.
 Lobbying is the practice of influencing decisions
made by government including attempts to influence
legislators and officials, whether by other
legislators, constituents or organized groups.
 A lobbyist is a person who tries to influence
legislation or regulation on behalf of a special
interest.
3

4. The Policy Conundrum – Multiple Players
• U.S. Congress
• The Administration
• Federal Courts
• State Courts
• Governors
• State Legislatures
 Involves
Policy, Resources, and
Conflicting Priorities
 The intersection of
Commerce, Governme
nt, and the Public
Interest
4

5. • Senate Appropriations - Labor, HHS, Education
and Related Agencies Subcommittee
• Senate Finance Committee - Health Care
Subcmte
• Senate Health, Education, Labor, and Pensions
Committee
• House Appropriations - Labor, HHS, Education
and Related Agencies Subcmte
• House Energy and Commerce Committee -
Health Subcmte
• House Ways and Means Committee - Health
Subcmte
• House Science, Space, and Technology –
Technology and Innovation Subcmte
• Caucuses and Special Interests
(Doctors, Nurses, Internet, Tech and Health
Congressional Committees of
Jurisdiction - Health Info Technology

6. 113th U.S. Congress - By the Numbers
New Congressional Profile - Results of the 2012
Election House Senate
Democrats 201 51
Republicans 233 45
Independents 0 2**
Vacancies 1 2*
Totals 435 100
*The two Senate vacancies are those of former Senators John Kerry (D-MA) who has become the Secretary of
State and Frank Lautenberg (D-NJ) who died June 3, 2013. House vacancy is that of Joanne Emerson who
resigned January 22, 2013.
**The two Independent members of the Senate are Angus King (I-ME), who was elected to Olympia Snowe’s
seat when she retired, and Bernie Sanders (I-VT); both of who caucus with the Democrats.
6

7. policy@himss.org 7
HIMSS Public Policy Team
HIMSS Board of Directors
(sets policy)
Public Policy
Committee
Government
Relations Staff
Government
Relations
Roundtable
(HGRR)
HIMSS Diversity
Business
Roundtable
Legal
Task Force
HIMSS Non
Profit Partners
Chapter Advocacy
Roundtable
(CAR)
State
Government
Relations Staff

8. HIMSS Public Policy Process
 HIMSS Board of Directors - sets policy
 Public Policy Principles – approved by
Board; provides continuing guidance
(Advocacy and Public Policy webpage)
 Call to Action - Top 10 Policy Positions –
expresses priorities
 Public Policy Committee – makes
recommendations
 Other committees, WG, and TFs (Legal, etc.)
 Public Policy Statements and Fact Sheets –
expresses Board established policy related
to specific issues
 HIMSS Government Relations Team –
implements the Board’s decisions and
HIMSS’ GR activities
HIMSS 2011 - 2012 Public Policy Principles policy@himss.org December 10, 2010
2011 – 2012 Public Policy Principles
December 10, 2010
SUMMARY
HIMSS is a cause-based, not-for-profit organization exclusively focused on providing
global leadership so that lives can be saved, outcomes of care improved, and costs
reduced by transforming the delivery of healthcare through the appropriate use of
information technology (IT) and management systems. Founded 50 years ago, HIMSS
and its related organizations have offices in
Chicago, Washington, DC, Brussels, Singapore, Leipzig, and other locations across the
United States. HIMSS represents more than 30,000 individual members, of which two
thirds work in healthcare provider, governmental and not-for-profit organizations. HIMSS
also includes over 470 corporate members and more than 85 not-for-profit organizations
that share our mission of transforming healthcare through the effective use of information
technology and management systems. HIMSS frames and leads healthcare practices
and public policy through its content expertise, professional development, and research
initiatives designed to promote information and management systems’ contributions to
improving the quality, safety, access, and cost-effectiveness of patient care.
Each year, HIMSS creates policy principles for all stakeholders to consider for inclusion
as provisions in legislation proposed by the U.S. Congress or state legislatures, or for
inclusion in federal and state regulations, to foster enhanced healthcare using IT. For
2011 - 2012, HIMSS addresses its policy principles in eleven separate categories:
1. Funding and Incentives
2. Quality and Outcomes
3. Organizational Structure
4. Safety, Standards, Infrastructure, and Innovation
5. Privacy and Security
6. Legal
7. Patient Empowerment
8. Equity and Access
9. Population Health
10. Workforce Development
11. Administrative Simplification
The American Recovery and Reinvestment Act of 2009 (ARRA) includes billions of
dollars in Medicare and Medicaid incentive payments for the "Meaningful Use" of certified
Electronic Health Record (EHR) technology and will help to close the health IT adoption
gap in the United States. We agree with Dr. David Blumenthal, of the Office of
Page 1 of 18
8

9. Top Items for 2013
– Fiscal Stability, C&BI, Value of Health IT to Secure MU
– Interoperability – Addressing Scrutiny from Congress
– Meaningful Use – Delivering on MU2; Preparing for MU3
– Affordable Care Act Requirements –Eligibility, EFT/ERA,
Insurance Exchanges, Results of Payment Reform Initiatives
– Fraud/Abuse/Compliance – Code of Conduct
– Patient Safety/ Device Regulation/Patient Data Matching
– ICD-10 Implementation – Relevance to HCT
– Workforce Development – New Careers, Hiring Vets
– Consumer Engagement & Mobile Health
– Privacy and Security 9

10. Top 3 Congressional Affairs Priorities for 2013
• Preserve HITECH EHR Incentive Program Funding In Austere
Times
• Advance the Patient Data Matching Strategy
• Educate the 113th Congress on Health IT Potential and Issues
– Dispel with Facts the Fraud and Abuse Concerns
– Impress upon Congress the Successes of the Health IT/MU Program
– Advance Congressional Understanding of Interoperability
– Advance Congressional Understanding of Privacy and Security
– Build Congressional Support for Adhering to the ICD-10
Implementation Date
– Focus on Key Committee Leadership and staff
– Focus on Educating New Members and staff

11. • The Economy and Jobs
• Federal Budget
• 12 Congressional Appropriations Bills
• The Federal Budget Deficit
• Entitlement programs (Social
Security, Medicare, and Medicaid)
• Sequestration
• Healthcare Reform
• (Medicare, Medicaid, CHIP)
• Congressional Reform
• Senate Rules on 60 votes to end debate
(filibuster) and rule allowing a single member
hold on legislation, earmarks, and the
appropriations process
Congressional Priorities for 2013
11

12. Sequestration
• Legal procedure to enact automatic across-the-board
spending cuts to non-exempt mandatory programs
– Programs exempted from sequestration were Social
Security, Medicaid, military pay and veterans’ benefits
• Reductions take effect January 2, 2013
• Time for Congress to pass new law prior to effective date
• President Obama has said he would veto any legislation to
modify this program
• Sequestration requires a minimum of $1.2 trillion in deficit
reduction over ten years
12

13. Potential Implications for Health IT
• Medicare Reimbursement under Sequestration limited to 2%
cut
– Excluding Medicare Sustainable Growth Rate (SGR) fix
• Any reduction in Medicare reimbursement not good for EHR
Adoption
• Uncertainty around implications for Health IT and HITECH EHR
Incentive Program
• Congressional intent is expressed in the HITECH Act
• Both Bush and Obama Administrations have supported
EHR/HIE Adoption
• Congressional leaders still express bipartisan support for
EHR/HIE Adoption
13

14. Congressional Interest in Health IT
Reboot: Re-examining the
Strategies Needed to
Successfully Adopt Health IT
April 16, 2013
• Senators John Thune (R-ND)
• Lamar Alexander (R-TN)
• Pat Roberts (R-KS)
• Richard Burr (R-NC)
• Tom Coburn (R-OK)
• Mike Enzi (R-WY)
14

15. Senators’ Reboot Whitepaper
1. Lack of Clear Path To Interoperability (HIMSS PPP Sec 4)
2. Misuse of EHRs May Actually Increase Health Care Costs
(HIMSS PPP #s 3.15 and 5.5)
3. Insufficient Oversight Has Put Taxpayer Money at Risk
(HIMSS PPP Sec 4)
4. Long-Term Questions on Data Security and Patient Safety
Remain (HIMSS PPP Sec 5 and 6)
5. Questions Remain About Long-Term Sustainability of the
EHR Program (HIMSS PPP #s 4.10 and 14.8)
HIMSS 2013 – 2014 Public Policy Principles
Approved by the Board of Directors on December 7, 2012
http://himss.files.cms-plus.com/FileDownloads/HIMSS-Public-Policy-Principles-2013-2014.pdf
15

16. Federal Healthcare issues
• Costs Control – Medicare and Medicaid
• Payment Reform
• Medicare Sustainable Growth Rate (SGR or “Doc Fix”)
• Quality and Value
• Provider Availability and Mix
• Access to Care / Rural / Underserved Communities
• Demographics
• Patient Engagement / Lifestyle
• Chronic Disease Management
• ICD-10 Adoption

17. .
 There were 7,031 bills and
variations of bills introduced in
the First Session (2011) of the
112th Congress alone
 Includes Senate House and
Bills, Joint Resolutions,
Concurrent Resolutions, and
Simple Resolutions
 Does not include the
multitude of amendments
offered
 Does not reflect the
multitude of
hearings, reports, markups
statements, press releases, and
floor debates and statements

18. Health IT Related Legislation at Federal Level
18
• HR 28, Working Families' Access to Health Innovations Act of
2013
• HR 756, Cybersecurity Enhancement Act of 2013
• HR 983, Online Communications and Geo-location Protection
Act of 2013
• HR 986, Rural Health Clinic Fairness Act of 2013
• HR 1309, Health Information Technology Reform Act
• HR 1326, Health Care Price Transparency Promotion Act of 2013
• HR 1331, Electronic Health Records Improvement Act of 2013
• HR 1379, Puerto Rico Hospital HITECH Amendments Act of 2013
• HR 1701, Cutting Costly Codes Act of 2013
• HR 1790, Health IT Modernization for Underserved Communities
Act of 2013

19. Health IT Related Legislation at Federal Level
(continued)
• HR 1913, Application Privacy, Protection, and Security Act of 2013
• S 612, Social Security Number Protection Act of 2013
• HR 523 Protect Medical Innovation Act of 2013
• HR 29, Mobile Medical Homeless Health Improvement Act of 2013
• HR 581, First Responder Medical Device Tax Relief Act
HR 1295, Medical Device Tax Elimination Act
• S 21, Cybersecurity and American Cyber Competitiveness Act of 2013
• S 232, Medical Device Access and Innovation Protection Act
• S 467, Wireless Device Independence Act of 2013
• S 490, Mobile Mammography Promotion Act of 2013

20. Health IT Related Legislation at Federal Level
(continued)
• Privacy and Security of Personal Health IT
• Meaningful Use Incentive Eligibility Expansion
• Regulation of Medical Devices and Apps
• Cybersecurity Enhancement
• Regulation EHRs as Medical Devices
• Broadband and Rural Access
• Mitigate Meaningful Use Adoption Penalties

21. TIER 1:
ONC
DoD*
VA
CMS*
CDC*
FDA
IHS*
HRSA*
OMB/EOP
HITPC + HITSC
TIER 2:
AHRQ, NIST, DO
C, OMH, OCR, S
SA,
NCVHS,
FCC
TIER 3:
OPM, DEA,
IRS, SAMSHA,
FTC, NSF,
USDA,
DHS, DoC
Federal Affairs Team Tiered External Focus
*Organizational Affiliate
Government
Services
21

22. 22
Regulatory Agency Regulatory Activity NPRM Due Date(s) Anticipated Final Rule
Published
Centers for Medicare and
Medicaid Services (CMS)
Hospital Inpatient Prospective Payment
Systems for Acute Care Hospitals and the
Long-Term Care Hospital Prospective
Payment System and Proposed Fiscal Year
2014 Rates; Quality Reporting
Requirements for Specific Providers;
Hospital Conditions of Participation
NPRM Comments Due:
June 25, 2013
TBD
Centers for Medicare and
Medicaid Services (CMS)
and Office of Inspector
General (OIG)
CMS: Medicare Program; Physicians’
Referrals to Health Care Entities With
Which They Have Financial Relationships:
Exception for Certain Electronic Health
Records Arrangements
OIG: Medicare and State Health Care
Programs: Fraud and Abuse; Electronic
Health Records Safe Harbor under the Anti-
Kickback Statute
Joint NPRMs Due:
June 10, 2013
TBD
Centers for Medicare and
Medicaid Services (CMS)
and Office of the
National Coordinator for
Health IT (ONC)
Request for Information on Advancing
Interoperability and Healthcare Information
Exchange
HIMSS Submitted Comments April 18, 2013
RFI Comments Due:
April 22, 2013
TBD
Federal Health IT Regulatory Activity

23. 23
Regulatory Agency Regulatory Activity NPRM Due Date(s) Anticipated Final Rule
Published
Centers for Medicare and
Medicaid Services (CMS)
Request for Information on Use of Clinical
Quality
Measures (CQMs) Reported under the
Physician Quality Reporting System (PQRS),
the Electronic Health Record (EHR) Incentive
Program, and Other
Reporting Programs
HIMSS Submitted Comments April 8, 2013
RFI Comments Due:
April 8, 2013
NPRM TBD
Office of National
Coordinator for Health IT
(ONC)
Health IT Patient Safety Action &
Surveillance Plan for Public Comment –
Released December 21, 2012
HIMSS Submitted Comments February 4,
2013
RFC Comments Due:
February 4, 2013
Final Plan TBD
Centers for Medicare and
Medicaid Services (CMS)
Request for Information on Hospital and
Vendor Readiness for Electronic Health
Records Hospital Inpatient Quality Data
Reporting
HIMSS Submitted Comments February 1,
2013
RFI Comments Due:
February 1, 2013;
NPRM TBD
NPRM TBD
Office of Civil Rights (OCR)
Final Omnibus Privacy Rule: Breach
Notification, HIPAA Modifications,
Protected Health Information, GINA and
Privacy Protections
Multiple NPRMs led to
this Omnibus Final Rule
Final Rule Published
January 17, 2013
Federal Health IT Regulatory Activity

24. 24
Regulatory Agency Regulatory Activity NPRM Due Date(s) Anticipated Final Rule
Published
Centers for Medicare and
Medicaid Services (CMS)
Meaningful Use Stage 3 Request for
Comments to the Health IT Policy
Committee-- Released November 26
HIMSS Response Letter to Health IT Policy
Committee Proposed Meaningful Use Stage
3 Request for Comment
HIMSS Response to HITPC on Stage 3
Proposed Objectives and Measures
NPRM Anticipated TBD
2014; Stage 3 will not
be introduced in 2013
TBD 2014
Centers for Medicare and
Medicaid Services (CMS)
Administrative Simplification: Adoption of
Operating Rules for Electronic Funds
Transfer and Electronic Remittance Advice –
IFR Released. HIMSS Submitted Comments
October 9, 2012.
Released: August 10,
2012; Comments Due:
October 9, 2012
Now Final: No changes
from proposed IFR
HHS Office of Civil Rights
(OCR)
HIPAA Privacy Rule Accounting of
Disclosures under the Health Information
Technology for Economic and Clinical Health
Act
NPRM Released 2011 Final Plan Still TBD
Federal Health IT Regulatory Activity

25. policy@himss.org
25
Public Policy Tools and Resources
HIMSS Members and HIMSS Committees, WGs and TFs
www.himss.org/policy
Fact Sheets and Position Statements
Legislative Action Center
HIMSS Public Policy Principles
Calls for Action
HIMSS Health IT Policy Update (subscribe
at www.himss.org/policy/news_hitpu.asp)
HIMSS Advocacy and Public Policy
webpage www.himss.org/policy
policy@himss.org
Collaboration with other similar minded organizations

26. “Obama Care”
Patient Protection and Affordable Care Act 2010 (PPACA or ACA)
Signed March 23, 2010 (PL 111-148, PL 111-152).
• 2010: A new Patient’s Bill of Rights goes into effect, protecting consumers from the
worst abuses of the insurance industry. Cost-free preventive services begin for
many Americans.
2011: People with Medicare can get key preventive services for free, and also
receive a 50% discount on brand-name drugs in the Medicare “donut hole.”
2012: Accountable Care Organizations and other programs help doctors and health
care providers work together to deliver better care.
2014: All Americans will have access to affordable health insurance options. The
new Health Insurance Marketplace will allow individuals and small businesses to
compare health plans on a level playing field. Middle and low-income families will
get tax credits that cover a significant portion of the cost of coverage. And the
Medicaid program will be expanded to cover more low-income Americans. All
together, these reforms mean that millions of people who were previously
uninsured will gain coverage, thanks to the Affordable Care Act.

27. ICD-10 Implementation Date
• ICD-10 is the very basic foundation for other healthcare transformation
efforts, including Meaningful Use.
• ICD-10-CM/PCS will have positive implications for patients. Better clinical
intelligence data can describe multiple levels of severity, which should result in
improved care algorithms to support accurate, more individualized patient
care and lead to or promulgate improved outcomes.
• ICD-10-CM/PCS will provide more accurate payment structures for providers
over time.
• ICD-10 has the potential to reduce costly requests for health information.
• Increased research capabilities, quality metrics and public health tracking and
reporting made possible due to ICD-10 cannot be overemphasized
• The ICD-9 numbering system cannot accommodate today’s current medical
technology used for patient procedures
• Continued use of ICD-9, with its limited codes, will hinder progress towards
clinical best practice and evidence-based medicine.

28. The Meaningful Use Program
Stage 1:
2011-2012
Data capture and sharing
Meaningful use criteria focus on:
Stage 2:
2014
Advance clinical processes
Meaningful use criteria focus on:
Stage 3:
2016
Improved outcomes
Meaningful use criteria focus on:
• Electronically capturing health
information in a standardized
format
• More rigorous health
information exchange (HIE)
• Improving quality, safety, and
efficiency, leading to
improved health outcomes
• Using that information to
track key clinical conditions
• Increased requirements for e-
prescribing and incorporating
lab results
• Decision support for national
high-priority conditions
• Communicating that
information for care
coordination processes
• Electronic transmission of
patient care summaries across
multiple settings
• Patient access to self-
management tools
• Initiating the reporting of
clinical quality measures and
public health information
• More patient-controlled data
• Access to comprehensive
patient data through patient-
centered HIE
• Using information to engage
patients and their families in
their care
• Improving population health

29. Components of health IT
• Capturing Data – Electronic Health Records
• Interoperability – Exchanging Data – Coordination of Care
• e-Prescribing – Patient Compliance
• Quality Reporting and Improvement
• Clinical Decision Making Support
• Secondary Uses
• Public Health and Population Health Management
• Research and Clinical Trials
• Patient Engagement – Patient Portal / Personal Health Records
• Big Data Implications!

30. Health Information Technology Issues
• Historic Bipartisan Approach to Health IT
• Consumer/Patient Engagement
• Differing Privacy and Security Laws Across Jurisdictions
• Fraud/Abuse/Compliance
• Health Information Exchanges, Survivability
• ICD-10 Implementation
• Interoperability, Addressing Scrutiny from Congress
• Meaningful Use, Delivering on MU2; Preparing for MU3
• Mobile Health, Security, Regulation, Definition
• Nationwide Patient Data Matching Strategies
• Patient Safety/ Device Regulation/Patient Data Matching
• Privacy and Security
• Value of Health IT to Secure MU
• Workforce Development, Adequate Workforce, New Careers, Veterans
• Managing Expectations

31. Patient Identity Integrity Solution
• Information exchange requires accurate, robust patient
matching methods to ensure the right patients are
receiving the right treatments at the right time
• Unique patient identifier concept surfaced within the
healthcare industry to ameliorate mismatching and realize
full benefits of HIE to ensure patient safety
• 1998 Federal legislation prohibits HHS from studying the
feasibility or impact of national patient identifiers
• Prohibition has forced numerous marketplace solutions,
yet a lack of national standards has led to differing and
suboptimal approaches to patient-data matching
31

32. FDA Regulating EHRs as Medical Devices
• Per FDA, health IT has advanced so far
that the professional intermediary is no
longer required or used
• “Under the Federal Food, Drug, and
Cosmetic Act, health IT software is a
medical device.”
• Per voluntary reports from
patients, clinicians, and user facilities, the
FDA cites data indicating 260 reports of
HIT-related adverse events, including 44
reported injuries and 6 reported deaths
• FDA issued a final rule in February 2011
classifying “Medical Device Data Systems”
as low Class 1 Medical Devices, requiring
post-market surveillance
- Testimony of Dr. Jeffery Shuren, Director for FDA Center for Devices and
Radiological Health to the HIT Policy Committee 2/25/10
32

33. .
33
17
21
25
34
4042
48
51
57
72
0
10
20
30
40
50
60
70
80
2008 2009 2010 2011 2012
PercentofPhysicians
Percent of office-based physicians with EHRs: 2008-2012
SOURCE: ONC analysis of 2009-2012 National Electronic Health Records Surveys.
Basic EHR
Any EHR

34. .
34
9.4
12.2*
15.6*
27.6*
44.4*
71.9
85.2*
0
10
20
30
40
50
60
70
80
90
2008 2009 2010 2011 2012
PercentofHospitals
Basic EHR System Certified EHR
Percent of hospitals with EHRs: 2008-2012
Basic EHR includes clinician notes. A certified EHR has been certified as meeting federal requirements for the hospital objectives of Meaningful Use.
*Significantly different from previous year (p < 0.05).
SOURCE: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement

35. .
35
Progress of Eligible Providers in the
Medicare and Medicaid EHR Incentive Programs as of January 2013
Eligible HospitalsEligible Professionals
SOURCE: Medicare and Medicaid EHR Incentive Program Data

36. 7/23/2013 Office of the National 36

39. policy@himss.org 39
Institute for e-Health Policy
Launched in May 2008 under HIMSS Foundation.
Complimenting services of HIMSS Government
Relations Department.
Key Projects:
Capitol Hill Steering Committee on
Telehealth and Healthcare Informatics Seminars.
National HIT Collaborative for the Underserved: Public/Private
Partnership for a Healthier America in conjunction with HHS.
Executive-in-Residence Program.
Government Relations Internship Program.
National Health IT Week – September.

40. 40
HIMSSStrategic
Relationships
HIMSSContentand
TechnicalExpertise
Government
Relations
PublicAffairs,Media,Web
Services,andMarketing
RegionalandStateAffairs.
Chapters,andCARs
HIMSSBoard,Committees
&Members
HIMSS Public Policy Impactfulness
Education
MeetingServices

41. policy@himss.org 41
What happens in
Washington does matter!

42. Questions?
HIMSS Government Relations Team
Thomas M. Leary, MPA, CAE, FHIMSS, VP Government Relations, 703-562-8814
Leslie Irvine, Coordinator, Government Relations, 703-562-8815
Richard M. Hodge, MBA, MPA, Senior Director, Congressional Affairs, 703-562-8847
Elinore Boeke, Senior Manager, Public Policy Communications, 703-562-8817
Arnol Simmons, Manager, Public Policy Initiatives, 703-562-8826
Neal Neuberger, Executive Director, Institute for e-Health Policy, 703-508-8182
Kathie Westpheling, MPH, Manager, Public Policy, 703-562-8831
Simeon Niles, Executive in Residence, 571-437-6167
TBD, Senior Director, Federal Affairs, 703-562-8814
Stephanie Jamison, Federal Affairs, 793-562-8844
Katie Boyer, Federal Affairs, 793-562-8872
Evan Yeckley, Coordinator, Federal Affairs, 703-562-8824
HIMSS National Capital Area Office
4300 Wilson Boulevard, Suite 250
Arlington, VA 22203
policy@himss.org