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The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.Copyright © 2018 The Sequoia Project. All Rights Reserved.
State of the Union: Public Policy Panel
Moderator: Mark J. Segal, PhD – Principal, Digital Health Policy Advisors
Presenter: Lindsay Austin – Principal, Troutman Sanders Strategies
The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.
Administration Activity: 2018
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This administration . . . [is] not interested in incremental steps. We want to lay down bold new rules of the road, [provide] better value to patients, and make real progress . . . over the next several years
We’re not interested in micromanaging how . . . interoperability and patient usability are achieved. We are . . . setting out simple goals: Patients ought to have control of their records in a useful format, period. When they arrive at a new provider, they should have a way of bringing their records, period. That’s interoperability—the what, not the how.
HHS Secretary Alex Azar, 3/16/2018National Association of Community Health Centers
Focus: Interoperability, Patient Access, APIs, Data Liquidity
The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.
• MyHealthEData/Blue Button 2.0
o Launched in March 2018 with White House Office of Innovation and CMS
• Increased focus: HIPAA right of access via open (HL7 FHIR®) APIs
• CMS created role of Chief Health Informatics Officer (CHIO)
• ONC Health IT Advisory Committee: Last met on October 17
• TSP has engaged with CMS and ONC leaders
• CMS Annual Hospital Rule (April proposed/August final): TSP comments
o EHR Incentive Program/Meaningful Use now “Promoting Interoperability Program”
o 2015 ONC certification required in 2019: enhanced interoperability and APIs
o RFI on use Conditions of Participation to encourage interoperability
• CMS Physician Payment Proposed Rule (July): TSP comments
o Aligned with hospital rule: interoperability and patient access, burden reduction
Administration Activity
3
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• Trusted Exchange Framework & Common Agreement (TEFCA): TSP comments
o ONC released draft TEF January 2018–principles, terms & conditions for framework:
required by 21st Century Cures and highly relevant to TSP and related initiatives
o Draft US Core Data for Interoperability (USCDI)–expanding standard data for exchange
o Extensive stakeholder comments under review by ONC
o Pending: Revised TEF for public comment, funding opportunity announcement for
Recognized Coordinating Entity (RCE), proposed and final Common Agreement
• ONC Proposed Rule on 21st Century Cures Interoperability: TSP will comment
• Received at OMB Sept. 17 and under review
• Information Blocking: “reasonable and necessary exceptions”
• Updates to certification: information blocking, “open APIs without special effort,” real-world testing
• TEFCA: meaning of sign-on
• ONC EHR Reporting Program: TSP Comments Oct. 11
• CMS Proposed Rule on Interoperability and Patient Access
• Received at OMB Sept. 21 and under review
• Expected focus: API-based access to payer data
Administration Activity
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The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.
Legislation
• VA Mission Act
• Opioids Package
• FY2019 Appropriations
Activity
• Health Care Innovation Caucus
• Newly formed VA Health IT
subcommittee
115th Congress Activity
5
The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.
• S. 2372 VA Mission Act signed into law by President Trump on June 6, 2018
o Bill creates a new Veteran Community Care Program giving improved access to healthcare and removes previous restrictions
o Sec 132. Improving Information Sharing with Community Providers: clarifies current law regarding EHR info sharing with non-VA providers
Why should we care about VA Mission
Act?
• Now allows VA to adjust its electronic
data sharing to an “informed opt-out”
option for veteran patients
• No longer requires signed
authorization to share records with
community providers, such as those
using eHealth Exchange
TSP worked with Members and
committees to advise on this language
and continues to act as resource
VA Mission Act
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The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.
• H.R. 6 The SUPPORT for Patients and Communities Act, “The Opioids Package”, signed into law
• 600 page package combines over 50 different bills addressing the national opioid crisis
• Non-partisan achievement for this congress and the Administration
• Opioids will be a continued policy focus and expect more legislation to be introduced
• Health IT Related Provisions include:
• Improvements to PDMPs, where providers are required to check a patient’s history before prescribing,
allows states to access and share data more easily, and improves efficiency of PDMPs
• Creates a pilot program to test payments to behavioral health providers adopting certified EHR technology
• Includes “Jessie’s Law” which requires HHS to develop best practices for displaying substance
use disorder treatment information in EHRs
• Advances electronic prescribing of controlled substances and electronic prior authorization under
Medicare Part D
• Requires Comprehensive Opioid Recovery Centers to operate a “secure, confidential, and interoperable” EHR
Opioids Package
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FY2019 LHHS bill signed into law Sept. 28
o Funds agencies including HHS, CDC, CMS, ONC,
FDA, etc.
o Congress provided $60.4M for ONC, which is level
with its FY18 budget but $21M over the President’s
FY19 budget request
o LHHS bill includes key Patient Matching Report
Language, an on-going mission for health IT
stakeholders
TSP advocated for the Patient Matching report language
with industry stakeholders and will continue to support
Why does the Approps process matter?
o Annual funding is critical for agencies to plan, hire, and
manage. Helps agencies perform their “missions”
such as implementing the 21st Century Cures Act and
other programs
Patient Matching Language
“The Committee is aware that one of the most significant
challenges inhibiting the safe and secure electronic exchange
of health information is the lack of a consistent patient data
matching strategy. With the passage of the HITECH Act, a
clear mandate was placed on the Nation’s healthcare
community to adopt electronic health records and health
exchange capability. Although the Committee continues to
carry a prohibition against HHS using funds to promulgate
or adopt any final standard providing for the assignment
of a unique health identifier for an individual until such
activity is authorized, the Committee notes that this limitation
does not prohibit HHS from examining the issues around
patient matching. Accordingly, the Committee encourages the
Secretary, acting through the Office of the National Coordinator
for Health Information Technology and CMS, to provide
technical assistance to private-sector led initiatives in
support of a coordinated national strategy for industry and
the federal government that promote patient safety by
accurately identifying patients to their health information.”
FY2019 Appropriations
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The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.
House Health Care Innovation Caucus
o Reps. Mike Kelly (R-PA), Ron Kind (D-WI), Markwayne
Mullin (R-OK), and Ami Bera (D-CA)
o Caucus seeks to advance innovative policies that
improve the quality of care and lower costs for
consumers
TSP presented to Caucus staffers at Ways & Means
Committee roundtable this year with HIMSS
o Caucus issued RFI
TSP responded to RFI in July with a focus the health
technology innovation section
Why should we care about this Caucus?
• Bipartisan forum to inform policymakers focused on
health IT priorities, opportunity to educate. Will host
roundtables and discussions
House Veterans Affairs Committee
o Formed the Subcommittee on Technology
Modernization in July
o Co-chaired by Reps. Jim Banks (R-IN) &
Conor Lamb (D-PA)
o Will oversee VA’s EHR modernization efforts and
other health IT policies impacting veterans
o Held first hearing in September on the role of the
Interagency Program Office in VA EHR
modernization
Why should we care about this subcommittee?
• Opportunity for TSP to advise and educate
policymakers and staff on initiatives with VA and
DOD
115th Congress Activity Cont.
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• Countdown = 12 days
• House of Representatives
• Senate
• Committee Outlook
2018 Midterm Elections – November 6
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• 435 House seats up for reelection
• Current breakdown:
o 235 Republicans
o 193 Democrats
o 7 vacancies (2 D, 5 R)
• Democrats need to net 23 seats for a 218
majority
• Since 1950, sitting President’s party has
averaged a loss of 24 House seats in
midterm elections
• Over 70 new members expected from
resignations, retirements, etc.
• Key retirements and departures;
o Speaker Paul Ryan (R-WI)
o Marsh Blackburn (R-TN) – Vice Chair
E&C Health
o Gene Green (D-TX) – Ranking
Member E&C Health
o Tim Walz (D-MN) – Ranking Member
Veterans’ Affairs
o Diane Black (R-TN), Greg Harper (R-
MS), Beto O’Rourke (R-TX), and Pat
Tiberi (R-OH) – All Health IT
Supporters
U.S. House of Representatives
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The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.
• 35 seats up for reelection
o Republicans defending 9 seats
o Democrats defending 26 seats
• Current breakdown:
o 51 Republicans
o 49 Democrats (w/ 2 Independents)
• Competitive Races:
• R: AZ, TN, NV, and possibly TX
• D: ND, FL, IN, MO, MT, and possibly WV
• Departures: Hatch, Corker, Flake, Cochran, Sessions, Franken, McCain
U.S. Senate
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The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.
“We gave four good pollsters the same raw data. They had four different results.”
-Nate Cohn, NYT Correspondent on 2016 election
House
o FiveThirtyEight Forecaster: Democrats
have 6 in 7 chance (85.2%) chance of
winning control of the House
o Cook Political Report: 30 seats currently
considered a “toss-up” (1 D and 29 R)
Senate
o FiveThirtyEight Forecaster: Republicans
have 4 in 5 chance (81.3%) keeping
control of the Senate
o Cook Political Report: 9 seats currently
considered a “toss-up” (4 D and 4 R)
1 D rated leans R (ND)
What do the Polls Say?
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Kaiser Family Foundation: Health care is top issue for Democrat/Independent voters, and
immigration and the economy are the main issues for Republican voters. Issues bring voters to the
polls and turnout matters!
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• Lame Duck Session, Post Election
o CR Expires Dec 7 (7/12 Approps bills)
o Nominations: Judicial, UN, AG, others
o Tax Package
o Farm Bill
o Immigration/Wall Funding
• 116th Congress
o President’s Budget Request
o FY2020 Appropriations
o Trade Deals
o Politics!
Lame Duck & Beyond…
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The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.
Leadership Votes will likely happen in Lame Duck
Committee Assignments likely early 116th
Energy and Commerce Committee – Greg Walden (R-OR)/Frank Pallone (D-NJ)
Subcommittee on Health – Michael Burgess (R-TX)/Gene Green (D-TX) (Eshoo/Pallone)
Ways & Means – Kevin Brady (R-TX)/Richard Neal (D-MA)
Subcommittee on Health – Peter Roskam (R-IL)/Sander Levin (D-MI) (Mike Thompson)
VA Committee – Phil Roe (R-TN)/Tim Walz (D-MN) (Mark Takano)
Subcommittee on Tech Modernization – Jim Banks (R-IN)/Conor Lamb (D-PA)
HELP Committee – Lamar Alexander (R-TN)/Patty Murray
(D-WA)
Finance Committee – Orrin Hatch (R-UT) (Crapo/Grassley)
/Ron Wyden (D-OR)
VA Committee – Johnny Isakson (R-GA)/Jon Tester (D-MT)
Other Committees to watch:
o Appropriations
o Oversight
o Armed Services
o Commerce (privacy)
Congressional Committee Outlook
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Key House Committees Key Senate Committees
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Public Policy Panel
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Jamie Ferguson
Kaiser Permanente
Vice President of Health
Information Technology &
Policy
Sam Burch
HIMSS
Senior Director,
Congressional Affairs
Jitin Asnaani
CommonWell Health Alliance
Executive Director
The Sequoia Project 2018 Annual Member Meeting Copyright © 2018 The Sequoia Project. All Rights Reserved.Copyright © 2018 The Sequoia Project. All Rights Reserved.
QUESTIONS?
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