Too many unanswered MU questions in proposed SGR fix

There's been a lot of hoopla about how a bipartisan group in Congress has finally reached a deal to repeal the much maligned sustainable growth rate (SGR) formula, the method currently used to compensate physicians participating in Medicare. 

The proposed legislation, currently in several House and Senate committees, is impressive. It proposes to radically change the payment methodology for physicians by creating a four-part, merit-based incentive payment system (MIPS). It combines the incentive payments and reporting requirements of the Meaningful Use program, the Physician Quality Reporting System and the Value Based Modifier.

The bills also tackle several other areas of debate, such as requiring electronic health records to be interoperable and studying the feasibility to creating a website so people can compare the functionality of different EHRs, a nod to patient safety and transparency. All very good, and in some respects long overdue.  

Of course, most of the attention has been on the SGR repeal itself, which is understandable.

But a deep dive into the actual language of the bill raises a slew of questions regarding EHRs that need to be answered before this bill becomes law.  

The first is how the bill dovetails with the existing Meaningful Use program. Now, plenty of lawmakers have expressed concern with the program, suggesting that it be paused, rebooted or even halted. The proposed SGR bill significantly revamps but doesn't repeal the entire Meaningful Use program.

It also doesn't describe how the revamped program will work.

For instance, one of the four components of MIPS is that EPs still must meaningfully use their EHRs. The secretary of the U.S. Department of Health & Human Services will determine if an EP is a meaningful user. There will be clinical quality measures to be met.

But are they the same ones as in the Meaningful Use program? Will they carry over to the new program? Or does HHS have to establish different clinical quality measures?

Also note that this mash up of the Meaningful Use program with other incentive programs amends only the section of the Social Security Act pertaining to payment for physician services. 

Does that mean the bill would leave the hospital side of the Meaningful Use program intact? Or should some provisions, such as the early sunset of payment adjustments in 2017, be extended to hospitals?

And isn't it more of a burden on HHS, the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT to manage two now vastly different Meaningful Use incentive programs? Will the agencies receive additional funding for that?

Also, take a look at the requirement that certified EHRs be interoperable by the end of 2017, using "common standards." What are these common standards? Does that mean HHS needs to create new common standards, or require existing common standards?

And would that make the health information exchanges obsolete?

What's more, the bill requires EPs and hospitals to demonstrate, by attestation or some other process, that they did not "knowingly" or "willfully" take acts to limit or restrict interoperability. OK, but what about EHR design issues impeding interoperability? What if a provider knows that a design feature impedes data sharing, or that a vendor has been reluctant to support information exchange? Is that "knowingly?" Seems unclear.

Plus we've just witnessed that false attestation to HHS under the Meaningful Use program can lead to a criminal indictment. Ouch. Is that what Congress intended with this new attestation requirement?

This bill makes good headway in dealing with some of the outstanding issues in the healthcare industry. But Congress, please resolve these unanswered issues. Otherwise you'll be calling to "reboot" this program in a few years, too. - Marla (@MarlaHirsch @FierceHealthIT)

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