Alexander to Administration: 5 Reasons to Take More Time Before Making Final the Stage 3 Rule for the Electronic Health Records Program

Urges administration officials to give doctors and hospitals “time to get it right” so patients can benefit from better care

Posted on October 1, 2015

WASHINGTON, D.C., Oct. 1 – Senate health committee Chairman Lamar Alexander (R-Tenn.) today gave administration officials five reasons to take more time before making final the stage 3 rule of the federal government’s program to require doctors and hospitals to create electronic health records systems.

“The whole purpose of this program is to benefit patients, so that they and their health care providers have quicker and better access to their health histories and their doctors and hospitals and pharmacists can provide them with better care,” Alexander told administration witnesses at today’s hearing, the committee’s sixth on electronic health records.

“There is no reason not to take time to do it right, and there are plenty of reasons to do this.”

Alexander listed five key reasons: 

1) the fact that Stage two requirements are so complex that only 12 percent of physicians and 40 percent of hospitals have been able to comply, and rushing a stage 3 rule would make it harder to comply;

2) the administration’s new Medicare payment system pays out penalties and bonuses based in part on meaningful use compliance;

3) some of the nation’s leading medical institutions with the best electronic health records systems recommended taking more time;

4) a new GAO report that finds meaningful use requirements are actually preventing records systems from being able to communicate with one another;

5) the committee’s work with the administration to develop 7 areas of agreement for legislation to achieve interoperability. Alexander said, “It would make the most sense to make the final rule consistent with the goals of that legislation.”

Alexander said that “there is broad and bipartisan interest in seeing the administration take its time to get this done right,” noting that he and Senate commerce committee chairman John Thune urged this in a letter they sent the administration on Tuesday.

Also, a bipartisan group of 96 Republicans and 20 Democrats in the House of Representatives also, in a separate letter to the administration, urged it to “pause” the process of making stage three rules final.

The chairman’s full prepared remarks follow:

Over the last 5 years, the taxpayers have spent $30 billion to encourage doctors and hospitals to adopt electronic health records systems.

The whole purpose of this program is to benefit patients, so that they and their health care providers have quicker and better access to their health histories and their doctors and hospitals and pharmacists can provide them with better care.

This committee has had six hearings on this program because of problems with it

Making it succeed is essential to the biomedical research and innovation legislation we hope to finish this year.

It is especially critical to President Obama’s precision medicine initiative to assemble 1 million genomes and allow doctors to take advantage of the genomic information to prescribe the right medications in the right quantity at the right time.

It is also important to the shared goal between the administration and Congress to change the way the Medicare program pays doctors –so that Medicare is paying providers based on the quality, rather than the quantity of care they give patients. 

Under the new Merit-Based Incentive Payment System, 25 percent of a score that determines a provider’s penalty or bonus payment will be based on participation in meaningful use.

We are now entering a period where the government is penalizing doctors and hospitals if they do not adopt electronic health records systems.

Stage 1 of this effort has been a success and helped more than half of doctors and most hospitals to adopt these systems.

Stage 2 is not a success.  Only about 12 percent of doctors and 40 percent of hospitals have been able to comply with stage 2.

The administration has revised its rule for stage 2. Most people believe that this revised rule would be a big help.

I have urged that the modified rules already proposed for stage 2 of this program should be adopted immediately, because it will help doctors and hospitals comply with the government’s requirements.

I have also asked the government to make the rules final for stage three no sooner than January 1, 2017.  

The stage 3 requirements should then be phased in at a rate that reflects how successfully the program is being implemented.

Patients need an interoperable system that enables doctors and hospitals to share their electronic health records, but the government, doctors and hospitals need time to do it right. 

There is no reason not to take time to do it right, and there are plenty of reasons to do this. 

Here are five: 

  1. Stage two requirements are so complex that only about 12 percent of eligible physicians and 40 percent of eligible hospitals have been able to comply. The modifications to the rule should be adopted immediately so that providers can comply. Rushing out a stage 3 rule now would only make it even harder for doctors and hospitals to meet the program requirements. 
  1. The administration’s top priority is changing the way the Medicare program pays doctors –so that Medicare is paying providers based on the quality, rather than the quantity of care they give patients.

Under the new Merit-Based Incentive Payment System, 25 percent of a score that determines a provider’s penalty or bonus payment will be based on participation in meaningful use.

The formula for the merit-based incentive payment system was part of a law passed this year. Just this week, the administration has begun the process to develop regulations to implement that system. 

So it’s incredibly important to these doctors and hospitals to get the meaningful use program right.

  1. Some of the leading medical institutions in the country with the best electronic health records systems recommended that we take more time to develop the stage 3 rule.

Physicians and hospitals have said to me that they are literally "terrified" of stage 3, because of the complexity and because of the fines that will be levied.   

  1. This week I released a report that I requested, along with several other senators, from the Government Accountability Office, which found that many of the meaningful use program’s rules and requirements for electronic health records are actually preventing records systems from being able to communicate with one another – they are getting in the way of that critical exchange of data.

GAO polled 18 organizations in the private sector and at the state and local levels working to achieve interoperability and found that the majority of them – 10 of the 18—believe that “efforts to meet the programs’ requirements divert resources and attention from other efforts to enable interoperability.”

  1. As important as any other reason, we’ve been working with the administration diligently for months to develop 7 areas of agreement for legislation to actually achieve interoperability.

It would make the most sense to make the final rule consistent with the goals of that legislation.

Briefly – these 7 areas are:

  1. Decreasing unnecessary physician documentation;
  2. Enabling patients to have easier access to their own health records;
  3. Making electronic health records more accessible to the entire health care team, such as nurses;

And these next areas are especially critical to developing systems that achieve interoperability:

  1. Stopping information blocking
    1. This could be described as intentionally interfering with access to my personal health information;
  2. Ensuring the government’s certification of a records system means what it says it does;
  3. Improving standards; and
  4. Ensuring the security and privacy of patient records.

I had a piano teacher who always told me: “Play the music a little slower than you can play it and you’re more likely to get it right.”

I have given the administration that advice.

There is broad and bipartisan interest in seeing the administration take its time to get this done right. 

Senate commerce committee chairman John Thune also urged this in a letter we sent the administration on Tuesday.

A bipartisan group of 96 Republicans and 20 Democrats in the House of Representatives also, in a separate letter to the administration, urged it to “pause” the process of making stage three rules final.

The next steps in this committee and in Congress will be focused on having a big success in electronic health records rather than a big problem.

I hope that the administration has the same goal for its next steps. 

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