- Industry groups including the American Hospital Association are pushing back against a CMS plan that would make interoperability mandatory for organizations to bill Medicare and Medicaid.
- The proposed rule, issued in April, requested input on changing hospital Conditions of Payment and Medicaid Conditions for Coverage to require providers to share data electronically with other providers and, when possible, patients.
- In comments on the 2019 Inpatient Prospective Payment proposed rule, the AHA said it “strongly opposes creating additional CoPs/CfCs to promote interoperability of health information.”
Previously, CMS has rewarded providers moving toward interoperability with programs like Meaningful Use but refrained from any punitive measures for failure to do so. However, this year the agency has been more forceful, and CMS Administrator Seema Verma told the crowd at HIMSS18 it will no longer be acceptable to "limit patient records or to prevent [patients] and their doctor from seeing their complete history outside of a particular healthcare system."
While healthcare organizations want to promote interoperability, most of them don't seem ready to make reimbursement contingent on data sharing efforts, at least until there is more support built into the healthcare system.
“The AHA strongly supports the creation of an efficient and effective infrastructure for health information exchange,” the group wrote in a letter to Verma. “This is central to the efforts of hospitals and health systems to provide high-quality coordinated care, support new models of care and engage patient in their health."
The group said, however, they “do not believe a new mandate tied to CoPs is the right mechanism to advance information exchange.”
The College of Healthcare Information Management Executives (CHIME) echoed the concern that tying payments to interoperability is premature. “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,” the group wrote in comments to CMS. “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,” CHIME added. “The two should not be conflated.”
The ability to share medical data is important because it allows providers to coordinate care and know what other recent treatments and medications patients have been given. This can also help avoid redundant procedures or tests. In addition, the ability to gather and share large amounts of data can facilitate efforts to improve population health.
True interoperability, however, is a tough nut to crack. Doctors and health systems use a variety of different EHR platforms and data formats, while also keeping security and patient privacy requirements top-of-mind. Fewer than one in five hospitals reported using patient data from outside providers to inform care, according to a recent Health Affairs analysis.
One way to promote data sharing among various actors in the healthcare system is the use of health information exchanges, which can take a number of different forms. If CMS were to implement data sharing regulations as suggested in the proposed rule, it could be by requiring participation in such exchanges.
The Electronic Health Records Association also questioned the need for new Medicare CoPs, saying CMS should postpone any regulatory action on data sharing and interoperability until rulemaking required by the 21st Century Cures Act is complete.
“It is additionally unclear how interoperability expectations in the CoPs would be evaluated and audited, but it seems like that evaluation and auditing of these items would generate additional hospital burden,” the group added.
The AHA questioned CMS’ ability to enforce the interoperability requirement. Instead, the hospital lobby argues the agency should “focus its attention on resolving problems created by the lack of a fully implemented exchange framework, adoption of common standards and incentives for EHR and other IT vendors to adhere to standards." The group cited ONC’s Trusted Exchange Framework and Common Agreement as an example.