Might CMS Move to Implicitly Mandate Health Data Exchange at Discharge, at the Federal Level? | Mark Hagland | Healthcare Blogs Skip to content Skip to navigation

Might CMS Move to Implicitly Mandate Health Data Exchange at Discharge, at the Federal Level?

April 26, 2018
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CMS officials make broad hints about data-sharing in their release of a new proposed rule

Tuesday’s announcement on the part of the federal Centers for Medicare and Medicaid Services (CMS) that the agency is planning to drastically overhaul the meaningful use program, even to the extent of changing its name, was a big one. As Healthcare Informatics Managing Editor Rajiv Leventhal noted in his report two days ago, “In a press release, the federal agency said that it will be proposing to re-name the meaningful use program to ‘Promoting Interoperability.’ CMS said 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.”

Further, Leventhal noted, “The meaningful use (Medicare and Medicaid EHR Incentive Programs) program has been around since 2011 with the intent to encourage eligible providers to demonstrate meaningful use of certified EHR (electronic health record) technology. Seven years later, with nearly all hospitals and most physician practices having implemented a certified EHR, CMS is proposing a shakeup of the initiative with a rethinking of industry priorities.  Broadly,” he wrote, “the proposed rule issued today proposes 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). According to CMS, the policies in the IPPS and LTCH PPS proposed rule ‘would further advance the agency’s priority of creating a patient-driven healthcare system by achieving greater price transparency and interoperability—essential components of value-based care— while also significantly reducing the burden for hospitals so they can operate with better flexibility and patients have the information they need to become active healthcare consumers.’”

Among other things, Leventhal wrote, “The proposed policies begin implementing core pieces of the government-wide MyHealthEData initiative through several steps to strengthen interoperability or the sharing of healthcare data between providers.” And his report included the statement made by CMS Administrator Seema Verma that was contained in the announcement. “We seek to ensure the healthcare system puts patients first,” Verma a statement. “Today’s proposed rule demonstrates our commitment to patient access to high quality care while removing outdated and redundant regulations on providers. We envision a system that rewards value over volume and where patients reap the benefits through more choices and better health outcomes. Secretary Azar has made such a value-based transformation in our healthcare system a top priority for HHS, and CMS is taking important, concrete steps toward achieving it.”

What’s more, as Leventhal and Healthcare Informatics Associate Editor Heather Landi reported this morning in their follow-up article, “CMS is proposing to re-name the meaningful use program, now calling it “promoting interoperability.” But just how far the federal agency will go beyond “promotion” remains to be seen. For instance, deep inside the rule, CMS wrote that it is seeking public comment, via an RFI (request for information) on whether participation in the 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.”

Their story notes that “Those who have been close to the early meetings on TEFCA—which is the Office of the National Coordinator’s (ONC’s) plan to jolt the sluggish pace of progress on interoperability between providers— have praised the fact that provider participation in the initiative is currently voluntary. But,” they note in their article from this morning, “Jeff Smith, vice president of public policy at AMIA (the American Medical Informatics Association), believes that providers might actually be forced to participate after all.” Indeed, Smith told them, “One of the really interesting things is that nestled away [in the RFI] is that it says CMS 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 that would require them to transfer medically necessary information upon a patient discharge or transfer to do so electronically. A few other phrases are [also] in there, such as requiring hospitals to send discharge information to a community provider via electronic means, if possible, and requiring hospitals to make information available to patients, or a specific third-party application via electronic means, if requested.”

Further, they report, “[E]ven more thought-provoking, adds Smith, is TEFCA possibly counting as an HIE measure and objective in the new program.” In fact, he told them, “This could be wildly overblown, but one of the critiques of TEFCA is that it is voluntary and if you make it too hard, [no one] will do it. I always thought that was flawed logic, as the ONC EHR [electronic health record] certification program is voluntary, but nobody treats it like it’s voluntary if they want to be part of this world.”

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