Probe finds U.S. e-health program lacks oversight

Inspector general says physician and hospital self-reporting rule is ineffective

By , Computerworld |  IT Management, e-health, healthcare

In a a report last year, The Center for Public Integrity, a nonprofit investigative journalism organization, said the first incentive payments under meaningful use criteria to facilities that had implemented EHRs were made long before the program was in place.

The findings in the new report are based on audits of so-called EMR meaningful use "attestations." Eligible professions and hospitals either attest to the meaningful use of EMRs or designate designate a third party to register and attest on their behalf.

The Inspector General's report criticized the "self reporting" requirement in the EMR program because it lends itself to prepayment problems. The report concluded that CMS does not verify the accuracy of self-reported information prior to payment because data necessary for verifications are not readily available.

CMS also does not direct high-risk professionals and hospitals to submit supporting documentation for prepayment review, the report stated. The report also stated that Medicare should be able to review at least some payments before they are made to determine whether the hospitals and doctors are qualified.

"Absent changes to the definition of meaningful use, CMS should consider ways to strengthen its program," the Inspector General's report states. "Currently, CMS has not implemented strong prepayment safeguards."

The report recommends that CMS use risk analysis techniques to select post payment audits of healthcare professionals and hospitals that may be receiving payments before actually meeting meaningful use standard.

Responding to the report, Marilyn Tavenner, acting administrator for Medicare, said she doesn't believe a prepayment audit is currently necessary.

A prepayment audit could significantly delay payments to providers who have already paid out millions to deploy EMRs, Tavenner said.

Instead, she said a "batch" reporting mechanism that will allow healthcare providers to submit a report generated by their EMR for all of a group's individual healthcare providers is being implemented.

"CMS has implemented a number of prepayment verification edits to ensure that providers are eligible to participate in the Medicare EHR Incentive Program. In addition, CMS validates all of the EHR certification numbers that are provided by providers," Tavenner wrote in a letter responding to the report.


Originally published on Computerworld |  Click here to read the original story.
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