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Rule Roundup: Health IT Groups Respond to CMS’ Promoting Interoperability Proposal

June 27, 2018
by Rajiv Leventhal
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Industry stakeholders seem mixed on CMS’ impactful proposal around the possibility of requiring electronic data exchange to avoid being forced out of Medicare

Health IT associations have sent in their public comments on the Centers for Medicare & Medicaid Services’ (CMS) meaningful use rebranding proposed rule, with a key focus of the remarks centering around the government’s proposal to consider interoperability as a condition of Medicare participation.

A Review of the Proposal

For background, in late April, CMS proposed updates to Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). Included in the proposal was a re-naming of the meaningful use program to “Promoting Interoperability.” CMS said at the time that the goals of the new program will be to: make it more flexible and less burdensome; emphasize measures that require the exchange of health information between providers and patients, and incentivize providers to make it easier for patients to obtain their medical records electronically. 

Drilling down, however, the proposed rule has several interoperability elements to it beyond just a name change—some of which would have a significant impact on providers. For instance, as Healthcare Informatics reported at the time of the rule’s release,  CMS wrote that it would be seeking public comment, via an RFI (request for information) on whether participation in the Office of the National Coordinator’s (ONC’s) Trusted Exchange Framework and Common Agreement (TEFCA) should be considered a health IT activity that could count for credit within the health information exchange objective in lieu of reporting on measures for this objective.

Indeed, deep inside the rule, the federal agency suggested that it may consider revising the current CMS “Conditions of Participation” [which were originally proposed in the IMPACT Act and might be changed for future purposes] for hospitals, with the possibility of requiring providers to transfer medically necessary information upon a patient discharge or transfer to do so electronically.

What this means, according to experts who have analyzed the rule in depth, such as Jeff Smith, vice president of public policy at AMIA (the American Medical Informatics Association), who spoke to Healthcare Informatics in April, is that while the proposal does away with the meaningful use patient data access objective (view, download and transmit), “what this RFI [on the possibility of revising Conditions of Participations to revive interoperability] seems to be signaling is that they are not saying it’s not important to allow patients to view, download and transmit their information, but quite the opposite. CMS is signaling that they think it’s more important than participating in this little program that could cost you a percentage point or two in reimbursement. They think it’s so important that you don’t get participate in Medicare [if you don’t meet the Conditions of Participation],” Smith said at the time.

Stakeholders Respond

Health IT trade groups had until June 26 to send in their public comments on the rule, and after reviewing the remarks, there seems to be varied responses as it relates to requiring interoperability as a condition to participate in Medicare.

For one, the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) attested that CMS is taking the wrong approach. CHIME wrote in their comments, “Simply imposing regulatory requirements that make electronic data exchange a condition for providers to receive Medicare payment does not address the root issues at play. Addressing ongoing barriers is needed to speed greater progress around interoperability. Importantly too, a distinction must be drawn between speeding and increasing data exchange among providers and achieving a true state of interoperability. The two should not be conflated.”

The Chicago-based EHR (electronic health record) Association (EHRA) had similar sentiments as CHIME, noting that “We question the utility of new Conditions of Participation for Medicare around data sharing, especially in light of 21st Century Cures ongoing regulatory implementation. Further regulatory action on data sharing and interoperability should wait until the rulemaking mandated by 21st Century Cures is complete. For example, a CoP related to information blocking is contingent on ONC’s definitions on safe harbors.” EHRA added, “It is additionally unclear how interoperability expectations in the CoPs would be evaluated and audited, but it seems likely that evaluation and auditing of these items would generate additional hospital burden.”

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