If the Supreme Court knocks down the entire Affordable Care Act (ACA), it could have repercussions on health IT quality initiatives: quality reporting, quality measure development, the availability of Medicare data for performance measurement, enrollment in government programs and HIPAA transaction standards. That was the gist of a presentation by attorney James Wieland at a webinar sponsored by the Healthcare Information and Management Systems Society (HIMSS).
Wieland, a member of the HIMSS legal task force, focused his presentation on ACA provisions that reflect the government's involvement in quality reporting and benchmarking.
"Regardless of the fate of the ACA, a lot of this data-driven approach to improving healthcare quality and rewarding it in various ways will almost certainly continue," he said. But the federal government's role in driving this change would be scaled back, he added.
"It would not necessarily set health IT back for years, but it would stop this movement of the vast federal system into very active involvement with health IT in the areas of quality reporting and benchmarking."
Wieland specifically addressed these ACA provisions that an adverse High Court decision could knock out:
- Quality reporting: The Department of Health and Human Services must develop quality reporting requirements for group and individual health plans. If ACA is overruled, HHS won't have authority to force plans to disclose this data.
- Quality measure development: HHS is directed to make grants for the development of quality measures where none exist and to improve and update existing measures. Among other things, these metrics would be used to evaluate "meaningful use of health IT," although the HITECH Act, not the ACA, authorizes the Meaningful Use EHR incentive program.
- Availability of Medicare data for performance measurement: ACOs can already access some Medicare data, but this provision would make it "more generally available" to qualified entities, Wieland said.
- Enrollment in federal programs: HHS must develop protocols and interoperability to facilitate enrollment of individuals in federal and state healthcare programs. For eligibility purposes, this would allow the matching of applicant data against vital records, employment records, and tax records.
- Administrative simplification: ACA introduces the requirement to use operating rules for information exchange where a transaction standard or its implementation specifications are insufficient to achieve the desired goals. Wieland noted that HHS has already published final rules on operating procedures for verifying health plan coverage and claims status.
Previously, HIMSS predicted that if ACA is overturned, it would affect such health IT-dependent areas as "quality reporting initiatives, pay-for-performance initiatives, adoption of state HIEs, operating rules and standards and health IT work force development." HIMSS said it would also have an impact on accountable care organizations, the extension of the Physician Quality Reporting Initiative, and the Centers for Medicare & Medicaid Innovation.
Despite all of the changes that might occur if the Supreme Court strikes down the ACA, HIMSS still believes that the court's ruling might not kill healthcare reform. Nandan Kenkeranath, vice chair of the HIMSS Legal Task Force, told attendees that the decision on the individual mandate could still go either way. And the court could decide that the mandate is severable from the rest of the statute, aside from the pre-existing condition and guaranteed issue clauses, he said.
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