As the battle over the federal budget enters its second week, the debate has expanded beyond tying government operations to defunding the Affordable Care Act, to discussions of long term solutions for managing the federal debt ceiling.
While the federal government has gotten pretty close to this scenario a few times over the past decade, the last government shutdown due to lack of appropriated funds was in 1995.
What’s Happening in Congress
Since my pre-shutdown blog entry, attempts to tie federal funding to a one-year delay in the individual mandate for the Affordable Care Act and repeal of the Medical Device Tax have passed the House of Representatives, but were rejected in the Senate. The result has been a partial shutdown of the federal government to include the furlough of about 800,000 employees around the country, including most staff of the Office of the National Coordinator for Health IT.
The political brinksmanship has continued with the House focused on passing Continuing Resolution (CR)-style funding for programs such as National Institutes of Health, veterans benefits, and National Parks, and a few other high profile programs. The Senate has rejected each piece of legislation as it was presented.
Congress and the Administration will continue to debate possible scenarios to get the government running again. Speculation on when the shutdown will end is all over the map. One thing is certain: the closer they get to the October 17th deadline for raising the debt ceiling, the more pressure will be placed on Congress to identify at least a short-term solution.
Health IT-Related Activities HIMSS is Tracking
HIMSS has received a growing number of inquiries about the status of government health IT initiatives and how they may be impacted by the government shutdown. As of today, we have status on a few of the more frequent inquiries:
- Meaningful Use: Stage 2 got underway on October 1st without much fanfare. HIMSS has been calling for Stage 2 to start on time. We are awaiting feedback from the government on our Call to Action recommending a six-month extension of Year 1 of the Stage 2 attestation period, and understand that the letter from Senate Republicans requesting a one-year extension has caused considerable interest within HHS.
- Federal Advisory Committees: Federal Advisory Committees, including the HIT Policy Committee, HIT Standards Committee, and National Committee on Vital and Health Statistics, have been informed that they will not be meeting as full committees, workgroups, tiger teams, or other group settings during the government shutdown. The delay may have an impact on the timeline for Meaningful Use Stage 3.
- EHR Certification: Conversations with government and non-government experts have pointed to the fact that the certification program and Certified Health IT Products List (CHPL) will not be updated during the shutdown. Keith Boone has a great article in Healthcare IT News on what the impact will be on other standards and certification activities.
- Attestation: While over half of CMS staff is furloughed, those employees that work out of the HITECH program are still reporting to work. Eligible hospitals and critical access hospitals (CAHs) can still attest during the government shutdown. The last day that eligible hospitals and (CAHs) can register and submit attestation in FY13 for the Medicare EHR Incentive Program is November 30, 2013.
- Other Federal Regulatory Activities: We expect delays in federal rules on hospital and physician fee schedules, updates to the regulations on the Clinical Laboratory Information Act, and clarification on the Stark and Anti-Kickback Act exception and safe harbor for health IT products (sunset provision goes into effect on December 31st).
- Transition at ONC – It’s official: Dr. Farzad Mostashari and Mr. David Muntz have departed from ONC and Dr. Jacob Reider has become Acting National Coordinator for Health IT. HIMSS sent a letter to Secretary Sebelius offering our support as ONC transitions its leadership. When they return from the shutdown, we look forward to working with Dr. Reider and the rest of the ONC team to keep up the momentum on practical and innovative use of health IT that supports care coordination!
Bottom line: there are still many initiatives underway in the health IT space, but we can definitely see a slowdown in response time, and some programs are being cancelled or delayed until some level of appropriations are initiated.
What’s your health IT experience during the shutdown? Have you seen a dramatic decrease in government support?