Health IT areas to watch if Court overturns ACA

If the Supreme Court rules in June to strike the Patient Protection and Affordable Care Act (ACA), the action would not knock out health IT in general. However, it would delay the more active involvement of the federal government in health IT when it comes to quality reporting and benchmarking.

Raising performance criteria to the federal level will spread more broadly the adoption of electronic health records and, in turn, enable health reform, said James Wieland, principal at Ober, Kaler, Grimes & Shriver in Baltimore and a member of the HIMSS legal task force.

“It would certainly prevent or delay what I would see as a major step forward in the continued importance of health IT and its continued agility particularly in quality and performance measurement,” Wieland said during a recent online presentation sponsored by HIMSS.

Nonetheless, overturning ACA would not affect funding by the Health & Human Services (HHS) Department for other health IT programs, such as the electronic health record incentive program.

That said, the following ACA health IT-related provisions could be at risk:

Quality reporting by group or individual health insurance issuers offering coverage and provider reimbursements and designed to improve outcomes from reporting quality measures, care coordination, chronic disease management and best practices to assure quality of care. While already used in some areas, ACA could apply this broadly.

Quality measure development for calculating performance and improvement of population health, health plans and providers. HHS will consider a consensus-based group, such as National Quality Forum, and periodically identify gaps where no quality measures exist or where they need updating. Priority will be for quality measures for health outcomes and functional status of patients, care coordination, meaningful use of health IT, and the quality of information for patients to make informed decisions.

Availability of de-identified Medicare data for performance measurement to qualifying entities beyond accountable care organizations to assess performance of providers and suppliers. HHS will take steps to protect the privacy of individuals against tactics to combine unrelated databases to identify more patient information.

Health IT interoperable standards and protocols for the enrollment of individuals for federal and state programs, including providing individuals with notification of their eligibility in those programs. The standards would allow electronic matching against federal and state data, simplified submission of electronic documents for eligibility verification, and ability to expand databases to cover other federal programs.

Administrative simplification revises some HIPAA transactions standards to reduce clerical burden on patients, providers and health plans for compliance, including the concept of operating rules, which are necessary business rules and guidelines for the electronic exchange of information that are not defined by a transaction standard or its implementation specifications. Operating rules are designed to fill in areas where the transaction standards have not yielded the expected cost savings and administrative simplicity. HHS has put in effect the first two operating procedures for eligibility for health plan coverage and for healthcare claims status.

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