Policy Roundtable Abstracts - AcademyHealth

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experiences of adopters, measure progress towards HITECH program goals, and develop policies for the second stage of meaningful use criteria effective in 2013. Susan Dentzer is the Editor-in-Chief of Health Affairs, the nation's leading journal of health policy, and an on-air analyst on health issues with The NewsHour with Jim Lehrer on the Public Broadcasting Service (PBS). Ms. Dentzer will round out the panel by discussing the key questions she hears about electronic health records from policymakers, providers, and other stakeholders and the role that she sees digitalized health information playing in a reformed health delivery system. The panel will be chaired by Melinda Beeuwkes Buntin PhD, Director of the Office of Economic Analysis and Modeling within the Office of the National Coordinator for Health Information Technology (ONC) at HHS. She will introduce the panelists, give them each 10 minutes to deliver introductory remarks, and then ask them a series of questions including: • What is the biggest challenge providers face when deciding whether or not to adopt an EHR What additional policies might help them address that challenge • If you could go back and add one provision to the HITECH Act what would it be and why What might it cost • Research on health information technology is expanding rapidly. What is the most useful finding you’ve seen from the research community this year What would you like to know more about Geographic Equity in Medicare Payment Policy: Geographic Adjustment Factors and Value-Based Health Care Organizer/Moderator: Margo Edmunds Tuesday, June 14 * 8:00 a.m.–9:30 a.m. Panelists: Jon Christianson, Ph.D., University of Minnesota School of Public Health; Stuart Guterman, M.A., The Commonwealth Fund; Carlos Jaen, M.D., Ph.D., University of Texas Health Science Center at San Antonio; Marilyn Moon, Ph.D., American Institutes for Research; Thomas Ricketts, Ph.D., University of North Carolina, Chapel Hill Roundtable Summary: Medicare payments to physicians and hospitals are adjusted by geographic location, recognizing that some costs beyond the providers’ control vary in urban and rural areas and different parts of the country. Geographic adjustment is intended and designed to create a fee structure that compensates providers at the same real rate across the country. Before the Patient Protection and Affordable Care Act was passed, several members of Congress, policy experts, and clinical practitioners actively debated the need for an adjustment and the equity of the geographic adjustments for urban and rural areas and the data and methods used to calculate them. By Medicare statute, geographic adjustments must be budget-neutral, which forces a zero-sum game in which any adjustment upward for one provider or group of providers must be paid for by a downward adjustment to one or more other providers. Because there is no consensus in the provider community or among policy-makers on how to best adjust payments based on geographic location, The Secretary of Health and Human Services (HHS) and Congress sought advice from the Institute of Medicine (IOM) on how best to address stakeholders’ concerns as the new health care reform legislation is being implemented. The IOM study was commissioned to evaluate the accuracy of the adjustment factors and the methodology used to determine them, including the timeliness and accuracy of the sources of data used and their representativeness of operational costs of providers. The IOM was also asked to assess the effect of the adjustment factors on the level and distribution of the healthcare workforce and providers’ ability to provide high-value care, and the resulting impact on Medicare beneficiaries’ access to care. The participants in this policy roundtable will discuss the technical approach, findings, and recommendations of the IOM study’s first report to Congress and the Secretary of HHS, which will be released in May 2011. The participants include the study director and five members of the expert committee convened by the IOM to conduct the study. Their areas of expertise include health economics, health policy analysis, primary care, rural healthcare, geographic variation, healthcare workforce, and policy development and implementation. The study director, Margo Edmunds, PhD, will serve as moderator. Dr. Edmunds is a health policy analyst with a clinical background in disease management. She will provide a brief background on the scope and methods of the study and will introduce the IOM committee members who will serve as panelists. Marilyn Moon, PhD, is a health economist, Senior Vice President and Director, Health at the American Institutes for Research, and former Trustee for the Medicare trust fund. Dr. Moon will provide background on the Medicare payment structure for physicians and hospitals and describe the committee’s approach to evaluating data accuracy for the Hospital Wage Index. Stuart Guterman, MA, is Vice President, Payment and System Reform, and Executive Director for the Commission on a High Performance Health System at The Commonwealth Fund, and is a health economist with extensive experience in health care financing and payment systems. He will describe the committee’s recommendations about geographic payment localities and labor markets and their implications for urban and rural payment equity. Jon Christianson, PhD, Professor and James A. Hamilton Chair in Health Policy and Management at the University of Minnesota School of Public Health, is a health economist with expertise in health insurance, healthcare markets, and tracking change in healthcare markets. Dr. Christianson will describe the committee’s approach to impact analysis and the study’s implications for value-based healthcare delivery. Carlos Jaen, MD, PhD, is Professor of Epidemiology and Biostatistics, Co-Director of the
Center for Research in Family Medicine and Primary Care, and a practicing family physician at the University of Texas Health Science Center at San Antonio. Dr. Jaen will discuss the impact of the committee’s recommended changes in physician payment policies on primary care. Thomas Ricketts, PhD, is Professor of Health Policy and Management at the University of North Carolina Gillings School of Global Public Health. In October 2010, Dr. Ricketts was appointed to the National Health Care Workforce Commission created by the Patient Protection and Affordable Care Act. An expert in rural hospitals and health care access, Dr. Ricketts will discuss the implications of the committee’s recommendations for workforce distribution in rural and urban areas. The format for the roundtable will be interactive and will allow ample time for questions from members of the audience. Each presenter will offer a 5-7 minute statement summarizing key components of the study and recommendations from their perspective and area of expertise. Individual presentations will be followed by a Q and A led by the moderator and highlighting how the committee addressed conflicting stakeholder perspectives, such as whether the true costs of health care are recognized in high-cost urban areas and lowcost rural areas; whether the contributions of rural providers are undervalued or overvalued compared to those in urban areas; whether the occupational mix of clinical staff used for geographic adjustment is comparable in urban and rural areas; and whether socalled policy adjustments such as Graduate Medical Education or Health Professional Shortage Areas are accurate and fair. Health Information Exchange: Federal, State, and Local Perspective Organizer/Moderator: Ashish Jha Tuesday, June 14 * 9:45 a.m.–11:15 a.m. Panelists: David Blumenthal, M.D., M.P.P., Department of Health and Human Services; Rachel Block, New York State Department of Health; Richard Rubin, OneHealthPort; Julia Adler-Milstein, Harvard University Roundtable Summary: Health information exchange (HIE) is a central component of Meaningful Use of Electronic Health Records (EHRs), the criteria used by the U.S. government to pay incentives to providers and hospitals under the Health Information Technology for Economic and Clinical Health (HITECH) Act. Several models suggest that broad-based HIE could result in large financial savings and these projections have served to promote HIE alongside EHR adoption. Under the Bush administration, funding was made available to support local and regional HIE efforts. However, enabling the flow of key clinical data, both among providers and among providers and other stakeholders, was fraught with challenges. While some efforts were successful in facilitating clinical data exchange, few supported comprehensive exchange among all stakeholders in the region. In addition, many efforts were unable to find sustainable business models, address legal and regulatory barriers, or negotiate complex technical solutions, and as a result, they ultimately failed. HITECH reignited momentum behind HIE with both a clear business case in the form of incentives to doctors and hospitals to engage in exchange, and a new infusion of financial support to the entities facilitating exchange of data. Under the State HIE Cooperative Agreement Program administered by the Office of the National Coordinator for Health IT (ONC), funding is being awarded to states and state-designated entities to build out HIE capabilities. A total of $548 million in funding will be given to 56 states, eligible territories, and qualified State Designated Entities (SDE), and awardees are responsible for increasing the level of interoperability, enabling patient-centric information flow in order to improve the quality and efficiency of care. This requires that states put in place governance, policies, technical services, business operations, and financing mechanisms for HIE over the four-year performance period. While the goals of the program are clear, states still have substantial latitude in deciding how to fulfill them. States can therefore choose to have no direct role in the provision of HIE, or, on the other extreme, be the only provider of HIE services, directly connecting to all the relevant stakeholders. The benefit of a state-centric approach is greater flexibility in designing an HIE strategy that can take into account state-specific differences in the legal/regulatory environment, the structure of the health care delivery market and any existing efforts to establish HIE. However, many of the same challenges faced by local and regional HIE efforts are likely to be encountered by states, and so it remains to be seen how successful states will be in increasing the flow of clinical data between health care stakeholders. Our policy roundtable will provide a multi-level perspective on the current approach to achieving nationwide HIE. The moderator, Dr. Ashish Jha, an associate professor at the Harvard School of Public Health and national expert on health IT and HIE, will open with the background and motivation for the panel. Next, Dr. David Blumenthal, the National Coordinator for Health IT, will provide an overview of the current federal approach. We will then have representatives from two states, Rachel Block of New York and Rick Rubin of Washington, present their plans. This will be followed by Julia Adler-Milstein who will present recent survey data on the progress of local and regional HIE efforts across the U.S. We will conclude with a discussion of key challenges that lie ahead, facilitated by Dr. Jha. We describe the individual topics covered by each panelist below. David Blumenthal: In his role as National Coordinator for Health IT, Dr. Blumenthal was a principal contributor to developing the State HIE Cooperative Agreement Program. He will describe the goals,
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Policy Roundtable Abstracts - AcademyHealth

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