When are the government’s final rules around interoperability and patient access going to drop? What’s the latest with MIPS/MACRA? What’s going on these days with TEFCA? Is the MSSP ACO model shaping up to be the key to healthcare system redesign?
These were the questions asked at the Southwest Healthcare Innovation Summit, taking place on Nov. 14 at the Houston Marriott Medical Center, during a discussion on healthcare and healthcare IT policy between Jeff Coughlin, the senior director of federal and state affairs at the Chicago-based HIMSS and Healthcare Innovation Editor-in-Chief Mark Hagland. The two engaged in a robust conversation on the changing healthcare policy landscape and the many different elements of how current and future policy changes may impact healthcare technology leaders. Below are key excerpts of their talk.
Hagland: It feels like the debate around TEFCA keeps morphing. Where are we and what will happen next?
Coughlin: First, some background: TEFCA’s (the Trusted Exchange Framework and Common Agreement) creation was called out specifically by the 21st Century Cures Act, which said that ONC (the Office of the National Coordinator for Health IT) has to create a voluntary framework for trusted exchange, with the idea was that TEFCA could serve as a single on-ramp for nationwide interoperability for entities to use.
ONC has released two drafts of TEFCA so far, and is working on final guidance. In the interim, ONC will work with the Recognized Coordinating Entity (RCE), The Sequoia Project, to provide the governance and oversight of this single on-ramp idea. So now ONC and The Sequoia Project are working together to figure out how to better engage the public so they can finalize the guidance around TEFCA and also draft a common agreement. And I think this [common agreement] will come out in a draft document form again so that the public can respond to it.
Our primary concern with TEFCA Draft 2 was around the disruption that such a move to a trusted exchange framework could cause. The framework calls for creating Qualified Health Information Networks (QHINs), which take health information networks that exist now to another level since they have to meet certain requirements [to be outlined by TEFCA].
The idea is that these QHINs would share information amongst one another to create this nationwide web of data sharing. The issue here is that there are different approaches to data sharing out there now, but they’re not all working together—so the idea to bring them all together makes sense. But there are a lot of different business models involved, and we want to make sure we’re not causing too much disruption here. For example, some state-based HINs have [experienced] success, and a lot of their business models might have to change in order to make TEFCA work.
Hagland: Moving onto MIPS/MACRA, associations have expressed concern around the final rule that was just released. What are the core concerns here?
Coughlin: So, the newly created MIPS Value Pathways (MVPs) program is set for 2021 and is another iteration of MIPS. CMS (the Centers for Medicare & Medicaid Services) has tried to provide, through MVPs, a lot more flexibility for clinicians to use in order to achieve broader value-based care goals. But many details do need to get worked out. The availability of quality measures for specialists has been an issue. There are a lot of quality measures out there, but they’re more geared toward primary care rather than specialists.
Hagland: CMS has made it clear they want more and more organizations to engage in downside risk alternative payment models. How’s that landing for stakeholders?
Coughlin: Entities that have adopted a two-sided risk model have generated more shared savings than those who have not taken on downside risk, but folks are still very wary about engaging in two-sided risk because they don’t have a clear pathway to [move up].
Hagland: To that point, a recent Health Affairs study found that the advanced ACOs (accountable care organizations) are doing better than the less advanced ones. The study also found that the organizations that are doing really well in the MSSP (Medicare Shared Savings Program) have been there longer and have consistently done well, and not dropped out. They keep learning from what they’re doing.
Coughlin: In 2018, there were around 550 entities in the MSSP, and organizations are wary of joining, so there is a dip in new organizations that have applied to become part of the program for 2019. This is indicative of the information they have available and the work they need to do.
Hagland: That number, 550, sounds like a lot but there are large swaths of the country where not much is happening. So how do we get more organizations involved on this journey to value-based care, when maybe the only ones who are succeeding are the courageous ones?
Coughlin: ACOs are probably our best bet in terms of really doubling that shift from volume to value-based care. CMS has tried to push organizations into two-sided risk, but there will need to be other provisions built into the programs that allow for a longer [duration] in the program]. The new requirement is that you can only be in a one-sided risk model for two years before you need to take on downside risk, and that has kept a lot of organizations on the sideline. But overall, the MSSP is our biggest hope in trying to redesign the healthcare system.
And we have tried to emphasize to folks at CMS that there is so much great work happening, so what’s the best way to share that information across organizations so that you are learning from others? There is a lot of good work happening but it’s not being translated well to the public.
Hagland: Regarding the CMS/ONC proposed rules on interoperability and patient access, what’s the latest there and when might we see final rules?
CMS and ONC are working hard to finalize those rules, and that process sometimes can take long. ONC is having its annual conference at the end of January, so maybe that could be a good time to release its final rule. I do think that there were a lot of comments received that would require a significant change between what was proposed and what could be finalized, and there are several things included in the rules that will push things in the right direction—particularly around empowering patients and giving them control of their data. I don’t envision that focus going away, but it’s still very much a work in progress. Also, when will they go into effect? Obviously it won’t be January 2020, as the CMS rule intended, so maybe it will get pushed back to 2021 or 2022.
Hagland: What could organizations be doing so that they’re better prepared for all of these regulations?
Coughlin: There is great importance in making public comments, so, I would advise looking at these different proposals out there, figuring out how they will impact your organization, and then submitting comments on the record. HHS has a real appetite for hearing from the community, and folks in different organizations will have different use cases and different theses, so it’s important to work with associations and others to get involved.
