Mostashari Plays Good Cop, Unintentionally Making CMS Look Inflexible

Probably unintentionally, it seems like various HHS branches are playing good cop-bad cop right now.

I’m in Ojai, Calif., right now (please don’t hate me because of it) for the annual Association of Medical Directors of Information Systems (AMDIS) Physician-Computer Connection meeting, a gathering of chief medical information officers and others in the field of what AMDIS likes to call applied medical informatics. That contrasts with the American Medical Informatics Association (AMIA), which tends to draw more from the academic side.

The Office of the National Coordinator for Health Information Technology (ONC) apparently is the good cop. National health IT coordinator Dr. Farzad Mostashari was unable to make it out here from Washington, but he addressed the gathering by telephone. Unfortunately, he called into a cell phone hooked up to the PA system in a room already suffering from poor cellular coverage, so some of his words were clipped. But a few things were clear.

Mostashari indicated that he was in favor of delaying the start of Stage 2 of “meaningful use” to 2014, even for those who meet Stage 1 requirements this year. That’s the recommendation that the Health IT Policy Committee made to him a couple of weeks ago. Furthermore, if CMS approves the delay—CMS is producing and administering the EMR incentive program—Mostashari said that providers will be able to earn three years of Medicare and/or Medicaid bonus payments, not just two years’ worth, prior to the start of Stage 2.

That, not surprisingly, elicited some smiles and nodding from attendees. Mostashari, himself a medical informatics veteran with a primary care and public-health slant, played to the crowd by pointing out how health IT is accelerating real reform of American healthcare—not just an expansion of insurance coverage that to me is just throwing more money at a broken system. “We’re moving away from the fee-for-service model comfortably faster than we had anticipated,” he said.

Meanwhile, CMS came off looking like the bad guy, at least in contrast to ONC.

The agency already is taking a lot of heat from many parts of the healthcare world, which has heaped tons of criticism on the proposed Accountable Care Organizations rule. Just after Mostashari’s session, Ethan Moore, a health IT and HITECH Act specialist at CMS, hosted an update on the Medicare and Medicaid agency’s efforts in health IT, which included two other CMS technical specialists calling in on the phone.

One of the callers delivered a disheartening message to the 200 or so informaticists present: the Oct. 1, 2013, deadline to convert to ICD-10 coding is “firm.” That may not have surprised anyone, but it certainly seemed disappointing, given that there’s probably going to be more time available to achieve later stages of meaningful use.

Moore also showed slides that walked through the online application for attesting to meaningful use. Moore was an engaging speaker, albeit not as enthusiastic as Mostashari, but a lot of eyes still glazed over. Blame it either on the relatively early hour if you want, but I think it had more to do with the bureaucratic nature of the process. I suppose there isn’t much anyone can do about that. If there is, I’d love to know exactly what.