Hospital Impact: Trump, chaos theory and the OIG

Sign that says "changes ahead"
The Department of Health and Human Services Office of Inspector General coincidentally released its 2017 work plan the same week as the presidential election and its surprise outcome, which has thrown its plans up in the air.
Marla Hirsch
Marla Durben Hirsch

It is not yet possible to predict what President-elect Donald Trump’s administration’s policies will be when it comes to EHRs and health IT.

Will he embrace some of President Obama’s projects, like precision medicine? Will anything happen to the Office of the National Coordinator for Health IT and the review of certified EHR technology? And what happens to the fight against information blocking? Will that continue? Or become less important?   

So imagine how much more daunting it is for those in the government who have to follow through on policy in the face of all these questions, all this change and so much chaos. 

Let’s take, for example, the Department of Health and Human Services Office of Inspector General (OIG). The agency, which has been working on its 2017 work plan for months, coincidentally released it the same week as the presidential election and its surprise outcome.

The work plan covers a lot of ground in its quest for program integrity. But what happens to those programs now? And does the OIG get to pick and choose its priorities?

One of the areas of review in the work plan is the performance of the accountable care organizations in the Medicare Shared Savings Program (MSSP). The OIG is slated to review, among other things (like beneficiary assignment and shared payments), the extent to which participating providers use EHRs to exchange health information to achieve care coordination goals as well as providers’ use of EHRs to identify best practices and possible challenges to exchange and use of health data.

But the MSSP was created by the Affordable Care Act, which President-elect Trump has vowed to repeal. Will the MSSP survive at all? Even if it does, would these issues still be a priority for the OIG?

Another item in the work plan is the review of incentive payments made under the Medicare Meaningful Use program and CMS’ safeguards to prevent erroneous payments. The OIG also has on its agenda to review incentive payment data to identify providers that didn’t meet certain Meaningful Use criteria, CMS’ plans to oversee payments and corrective actions taken.

Will the Meaningful Use program even last in the new administration? GOP members of Congress have long lambasted the program and vowed to “reboot” it. Or would this receive a higher priority regardless of what happens to the program, since the OIG recovered millions of dollars in its review of Medicaid Meaningful Use payments?

And what about the OIG’s plan to scrutinize covered entities to determine whether they adequately protect EHR information created or maintained by certified EHR technology? The work plan specifically says it will be looking at security risk analyses, required by both HIPAA and the Meaningful Use program.  

But if the Office for Civil Rights is already auditing providers for HIPAA compliance and enforcing the law against violators, would the new administration find this topic redundant and have the OIG leave it alone?

Also, note that one of the OIG’s new agenda items is to review CMS’ implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), which folds the Meaningful Use requirements for physicians into MACRA’s new incentive programs. Will the OIG give this heightened, priority scrutiny as the new payment program on the block or back off and focus more on other areas, such as improper billing?

The OIG may even need to revise its “going forward” potential new issues. For the past two years, it’s noted that the agency will consider “the significant challenges that exist with respect to Health IT adoption; meaningful use; and interoperability across providers, across HHS, and between providers and patients. Future work may also examine the outcomes from health IT investments. The OIG expects to broaden its portfolio regarding information privacy and security, including issues that arise from the continuing expansion of the Internet of Things.”

But if those aren’t the priorities of the new administration, then that may not be where the OIG goes forward.

And that’s not even factoring in how much can even be accomplished if the agency is affected by promises to “drain the swamp” and its budget is cut.

These concerns and questions might seem to be in the weeds. But they have a profound effect on business, innovation, programs and people.

The direction and future of health IT is murky. But the OIG may be able to give us a clue. The updated work plan, expected spring 2017, may be one way to shed some light.