Acting CMS head promotes health information technology
Leslie Norwalk, Style and Substance
By John Reichard
CQ HEALTHBEAT NEWS
November 1, 2006
Leslie Norwalk, Style and Substance
Style was as much the question as substance on Wednesday as Leslie V. Norwalk delivered her first speech as acting head of the Centers for Medicare and Medicaid Services. Would she be like former CMS head Tom Scully, whose freewheeling and unscripted style made every press scrum an event reporters could ill afford to ignore? Or more like her immediate predecessor Mark B. McClellan, who displayed an almost inhuman capacity to never, ever, stray from his talking points?
Norwalk seemed too new on the job for her natural style to emerge, but her command of detail suggested she can be like McClellan, while her forays into informality — she referred at one point to moving Medicare away from being “a big dumb . . . indemnity payer” to a program that rewards efficient and higher quality care — suggested that her heart lies more in tapping into her inner Scully.
McClellan-like, Norwalk used her keynote speech to the World Healthcare Innovation and Technology Congress to dryly describe a series of demonstration programs CMS is undertaking to promote health information technology.
Scully-like, Norwalk made a bit of news in the press scrum afterward, saying that if Congress didn’t pass legislation soon promoting health IT, CMS might pursue new forms of administrative action to advance the field. But in what may prove to a Norwalk style that involves finding a middle ground between McClellan and Scully, Norwalk was careful not to be too specific about what that administrative action would be.
Recently appointed as acting administrator to replace the departing McClellan, Norwalk said the administration is hoping to work with Congress to move ahead with health IT. But “if Congress is unable to do something, we’ll also be taking a look at what ability we might have to help forward health IT on a regulatory basis,” she said.
CMS already has taken regulatory action to exempt hospitals and health plans from prosecution under federal anti-kickback laws if they donate health IT to physician practices.
But Norwalk said CMS is considering doing more to promote adoption of the technology through its authority to establish demonstration programs testing new forms of payment and health care delivery and through the use of Quality Improvement Organizations contracted with the program.
“We don’t want to impede . . . money going to providers who might need a little help,” Norwalk said. But “since Medicare pays for health care services and IT is simply not among them, we have to use things like demonstration authority or other approaches to help them pick up health IT.”
Norwalk also referred to promoting “interoperability standards” to ensure IT systems can effectively function together as a way to help promote adoption of the technology. “One of the things that can get in the way, of course is . . . if payers have all sorts of different standards across the board,” she said. “If we can help harmonize those standards, it makes it easier for providers,” she added.
Could demo authority be used to boost payments to acquire IT? Norwalk didn’t really say, but she didn’t appear to rule out the possibility. “Basically, the Medicare program really is not set up to pay for the adoption of health IT, but what we could be set up to do ultimately is to pay for performance,” she said. “If health IT helps you get to determine what performance is relative to standard measures, then that’s something that we’d like to move toward.”
Among the options CMS is considering is expanding current demos that try to promote adoption of health care IT by physician practices, she said. But “first we want to see ‘do these things work?’ before we turn around and expand them,” she added.
