Stage 2 Meaningful Use, Interoperability of EMRs and ICD-10. What is CMS, ONC and HIPAA Impact on Accountable Care Organizations?

Last week we attended HIMSS12 the national conference of HIMSS in Las Vegas. The pace of adoption of electronic medical records is increasing, and Dr. Farzad Mostashari, Director of the Office of the National Coordinator (ONC) from Health and Human Services (HHS) made a breath taking statement in his key note that he expects more care to be delivered in 2013 by providers using an EMR than not.   Wow – did he just suggest over 50% adoption of Electronic Health Records?

Dr. Farzad Mostashari photo
Dr. Mostashari, Director of ONC at his HIMSS Keynote

Current data suggests that we have achieved perhaps 15% of U.S. Medicare and Medicaid providers achieving meaningful use attestation via a regional extension center and CMS web portal, with perhaps 30% in some stage of development of implementing an EMR.

We also attended a session given by the primary author of Stage 2 meaningful use, Travis Broome from CMS.  There are revisions in the attestation process, timing of incentives and also a carrot and stick for industry adoption of standards for supporting quality measures (a key driver of payment reform and the shift away from fee for service medicine) in EMRs whereby CMS can either sweeten incentives or reduce them.

Although $27 billion has been put forth by HHS and CMS for EMR adoption, the real prize will be in determining who has access to the data of the EMR and how interoperability will be facilitated.  Vendors who are either providing EMRs or integrating with them are attempting to both embrace the Clinical Document Architecture (CDA) as well as differentiate from their competition.

One of the key questions will be how the EMR provides a foundation with the Health Information Exchanges (HIEs) for comparative effectiveness data over the life span of  a patient (sometimes called the continuum of care) and whether CDA standards currently proposed will accomplish that.   Informatics people call this “longitudinal clinical data.”  We’ll be speaking this spring on these topics and analyzing in future reports whether Accountable Care Organization enablement is on track.  While the $billions in meaningful use incentives are getting the spotlight today, the shift from Fee for Service (FFS) to evidence based medicine represents a tectonic shift in the $3 trillion health care economy.  When blended with ICD-10, we have a perfect storm for innovation and redistribution of wealth in healthcare.  Although ICD-10 has likely been delayed and some providers are relieved, the interaction between CMS, ONC, and HIPAA standards creates some interesting opportunities in the next five to ten years.  ICD-10 will provide the underlying content of diagnosis and procedure codes that will populate the EMRs and HIEs.

Keep watching the interchange between CMS, who sets the standards for Meaningful Use (i.e adoption of EMRs) and ONC that sets the standards for interoperability.  And, look for vendors with vision that can capitalize on the standards while achieving commercial adoption to enable Accountable Care Organizations.

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Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See and for more about the company.

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