CMS should improve its oversight of its electronic health record incentive program, according to a report by the Office of Inspector General released this month. The government watchdog agency faults CMS for both inadequate prepayment safeguards and insufficient postpayment monitoring of recipients of federal funding intended to help cover the costs of adoption and implementation of EHR.
As this blog noted earlier this month, some concerns have been raised in a Congressional hearing about how the approximately $7.7 billion in taxpayer funds have been spent to date under the HITECH Act’s incentive program. In its report, the OIG recommended that CMS:
Obtain and review supporting documentation from selected professionals and hospitals prior to payment to verify the accuracy of their self-reported information;
Issue guidance with specific examples of documentation that professionals and hospitals should maintain to support their compliance; and
Conduct prepayment reviews to improve program oversight.
OIG reported resistance from CMS regarding its recommendation to implement prepayment reviews, which CMS believes would increase the burden on practitioners and hospitals and could delay incentive payments. CMS agreed to take steps to improve program oversight. CMS’s response appears as an exhibit to the OIG report at page 30.
Next, the OIG turned to the Office of the National Coordinator for Health Information Technology (ONC), the government agency that establishes EHR standards and certifies EHR technology. OIG recommended that the ONC:
Require that certified EHR technology be capable of producing reports for yes/no meaningful use measures where possible; and
Improve the certification process for EHR technology to ensure accurate EHR reports.
ONC concurred with both recommendations, as noted in the letter from Dr. Farhad Mostashari appearing at page 32.
The report noted that CMS currently conducts prepayment validation of professionals’ and hospitals’ self-reported meaningful use information to ensure that it meets program requirements, mostly by checking the math in the reports and verifying EHR certification codes. OIG also noted that CMS plans to audit selected professionals and hospitals after payment using a similar method to select audit targets based on inconsistencies in their reported data. At the time of the OIG review, CMS had not yet completed any postpayment audits.
Among OIG’s findings were:
- CMS’s prepayment validation functions correctly but does not verify the accuracy of self-reported information.
- Sufficient data are not available to verify self-reported information through automated system edits.
- CMS does not collect supporting documentation to verify self-reported information prior to payment.
- CMS’s planned postpayment audits may not conclusively verify the accuracy of professionals’ and hospitals’ self-reported meaningful use information.
- Reports from certified EHR technology are not sufficient for CMS to verify self-reported information and may not always be accurate.
- CMS may not be able to obtain sufficient supporting documentation to verify self-reported information during audits.
Given budgetary pressure and ongoing Congressional oversight, it is likely that CMS and ONC will be looking more closely at how HITECH incentive funds are being applied in the coming year.