Health IT

What will become of MACRA, Obamacare, health IT? HIMSS boss weighs in (podcast)

HIMSS CEO Steve Lieber, who is retiring at the end of 2017, is preparing to depart at a time when health IT at a crossroads.

HIMSS Chicago 2015

The annual Healthcare Information and Management Systems Society (HIMSS) conference gets under way Monday in Orlando, Florida, with numerous preconference activities starting Sunday.

As more than 40,000 people descend on Central Florida for the grueling event, MedCity News talked to HIMSS CEO and President H. Stephen Lieber for what has become an annual ritual, at least for this reporter. As usual, it’s on tape.

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HIMSS17 is the last HIMSS conference with Lieber in charge; he announced in December that he would retire at the end of 2017.

Lieber is preparing to depart at a time when health IT is at a crossroads.

Healthcare organizations in the U.S. have spent the better part of the last 10 years installing and now optimizing electronic health records, though they continue to lag when it comes to sharing data across systems. And they continue to gripe about EHR usability and Meaningful Use requirements.

Providers in recent years also have grappled with updates to HIPAA regulations and the conversion to ICD-10 coding. Now, they face some new regulations affecting health IT.

Notably, the 2016 Medicare Access and CHIP Reauthorization Act (MACRA) is coming into force for ambulatory care. The rise of accountable care is “certainly having an impact already in terms of how care is not only delivered,” as well as how payers calculate reimbursements, Lieber noted.

They also face the uncertainty that comes with a change in administration in Washington.

Still, some things do remain relatively constant in health IT.

“The ongoing challenge in dealing with security, there is going to be an even greater focus this year as we try to bring more attention, more focus on what it takes to make sure that we’re handling data in a secure way,” Lieber said.

Clinical analytics has become a normal course of business in the field as well, though it has changed from merely clinical decision support and retrospective analytics to predictive analytics and machine learning. “As the field evolves, we’re evolving the programming with it.” Lieber noted.

Policy seems to be where a lot of intrigue is right now. It’s easy to make assumptions about what the new Trump administration might do, but assumptions are just that.

“Our ability to predict some of these things is really limited,” Lieber said.

Besides, it’s early. Tom Price was confirmed as secretary of the Department of Health and Human Services a little more than a week ago, and the Senate held hearings this week on Seema Verma to run the Centers for Medicare and Medicaid Services. But there is no other permanent leadership in other HHS agencies yet, including the Office of the National Coordinator for Health Information Technology, so don’t expect much change to health IT policy right away.

Still, the presidency and both houses of Congress are under control of the same party now. “More than likely on subjects like this, anything that comes out of the Congress is going to be signed,” according to Lieber.

Health IT does largely remain a bipartisan issue, though Republicans and Democrats might disagree on some specifics, Lieber noted. “This administration, like the past administration in terms of healthcare, is going to be very interested in trying to keep those costs down, and we all know that one of the ways of doing that is through the use of technology,” he says.

The Affordable Care Act certainly does not enjoy bipartisan support, but the two parties may be closer to each other than it seems on certain elements of the Obamacare law.

Even though the public talk might be “repeal and replace,” behind the scenes, lawmakers know the issues are more complicated than that. “Now, the conversation is nuance,” Lieber said. And he reiterated his belief that technology will play a central role, regardless of what healthcare reform looks like takes in the future.

The U.S. has caught up and even surpassed other developed countries in health IT adoption in the last decade or so. “We’re not going to go back on that. We’re not going to rip out electronic medical records and replace them with paper records,” Lieber said.

Some things are up to the industry to figure out, notably, interoperability of healthcare data. Could the Fast Healthcare Interoperability Resources (FHIR) standard be the game changer that some would have the world believe?

“Game changing requires multiple factors and components, starting with attitudes. I don’t think we necessarily have the attitude yet where everybody’s bought into real data sharing and interoperability,” Lieber said. “If we continue to operate under the attitude that data is proprietary, it doesn’t matter what the technology is.”

Podcast details: Interview with HIMSS CEO and President Steve Lieber ahead of HIMSS17 conference. MP3, file size 29.3 MB. Running time 29:54. (Click here to download.)

0:50 What’s changed and what hasn’t since last year at the HIMSS conference
4:00 What direction the Trump administration might take in health IT
7:15 The future of the Affordable Care Act and what that means for health IT
9:25 How health IT has grown the U.S. in the last 10 years
11:40 MACRA, MIPS and the tall task of educating providers about the new CMS Alternative Payment Models
15:50 State of interoperability
18:30 Slower process of MACRA and MIPS implementation because of the change of administration
19:20 Price’s record from his years in Congress
22:05 The next horizon in health IT
25:00 Advice to first-time HIMSS attendees
26:10 What he is excited about at his last HIMSS conference as the CEO
27:55 Surprises and accomplishments in his 17 years at the helm

Photo: MedCity News