Medicaid has entered a period of volatile change, unprecedented in its 51-year history. With 74 million members nationwide,1 Medicaid provides health coverage to more than one in four Americans, ensuring access to healthcare not only for children, pregnant women, the elderly and people with disabilities, but also for an increasing number of low-income working adults. 2017 saw repeated attempts to fundamentally restructure the Medicaid program, and although Congress is likely to turn its attention to other priorities in 2018, federal legislative efforts to revamp Medicaid remain in play. Short of congressional action, vigorous efforts by federal offi cials to use administrative authority to reshape the program is a certainty. And perhaps more than ever before, states will test the limits of their purchasing power and federal fl exibility to make changes to their programs—driven by the desire to improve value, reduce the rate of expenditure growth, and shape the program to meet their policy and political objectives. At the boundaries of these federal and state efforts, expect the courts to weigh in.

On January 25, 2018, eHealth Initiative (eHI) held its annual Government Affairs Retreat at the Dirksen Senate Office Building on Capitol Hill. The gathering convened eHI members and policy experts to discuss the 2018 federal legislative and regulatory landscape. During this day long meeting, participants shared important, up-to-the-minute intelligence on healthcare priorities for Congress and the Administration; identified impactful federal policy and regulatory shifts; and developed policy priorities and action items for eHealth Initiative, and its members, for the upcoming year.

Presentation slides from McDermott and Consulting and McDermott Will & Emery from eHI's Government Affairs Retreat held 1/25/18.

Presentation slides by Jean Moody-Williams, Deputy Center Director, Center for Clinical Standards and Quality, CMS, featuring updates from CMS. From eHI's Government Affairs Retreat held on 1/25/18.

eHealth Initiative’s 2017 Provider Survey on Access to Patient Information examines perspectives on:
• Increased access to patient information
• Interoperability
• Changing regulations, including compliance with Merit-Based Incentive Payment System (MIPS) and Meaningful Use (MU)
• Latest findings on provider-related interoperability solutions, which drive outcomes and organizational priorities

After careful analysis of the survey results, the following key findings emerged:

• Key Finding 1: Patient engagement appears to be increasing, with more patients accessing their health information and managing how it is shared
• Key Finding 2: Providers are struggling to meet patient access regulations, which do not necessarily align with business needs
• Key Finding 3: Changing federal requirements, and the costs associated with them, are causing great concern among providers
• Key Finding 4: Current interoperability solutions do not meet the needs of providers
• Key Finding 5: Patient security, privacy and confidentiality remain top concerns amongst providers
• Key Finding 6: Professional societies and industry groups play a key role in educating providers on new regulations
• Key Finding 7: EHR vendors are viewed as “helpful” in addressing current patient access regulatory requirements
• Key Finding 8: Providers are engaged in a variety of alliances and participate in different interoperability frameworks
• Key Finding 9: Providers prioritize connectivity in a variety of ways

Consumer Mediated Exchange, presented by Hon Pak, CMO, 3M Health Information Systems Division

Abstract:

Background: Little is known about how physician time is allocated in ambulatory care.
Objective: To describe how physician time is spent in ambulatory practice.
Design: Quantitative direct observational time and motion study (during office hours) and self-reported diary (after hours).
Setting: U.S. ambulatory care in 4 specialties in 4 states (Illinois, New Hampshire, Virginia, and Washington).
Participants: 57 U.S. physicians in family medicine, internal medicine, cardiology, and orthopedics who were observed for
430 hours, 21 of whom also completed after-hours diaries.
Measurements: Proportions of time spent on 4 activities (direct clinical face time, electronic health record [EHR] and desk work, administrative tasks, and other tasks) and self-reported afterhours work.
Results: During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37.0% on EHR and desk work. The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks.
Limitations: Data were gathered in self-selected, highperforming practices and may not be generalizable to other settings.
The descriptive study design did not support formal statistical comparisons by physician and practice characteristics.
Conclusion: For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work.

Sinsky et al., 2016