Four officials from the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) reviewed key elements of(on Monday morning), on Thursday afternoon, Feb. 14, at HIMSS19, while it was being held at the Orange County Convention Center in Orlando.
In Session 233, billed simply as “Initiative to Advance Interoperability,” Alexandra Mugge, deputy chief informatics officer at CMS, reviewed some of the main elements in the CMS proposed rule that had been announced Monday (though it has not yet been published in the Federal Register), and then asked her fellow officials—Thomas Novak of the Center for Medicaid and CHIP Services (CMCS) at CMS, Lisa Bari of the Center for Medicare and Medicaid Innovation (CMMI) at CMS, and Beth Myers of the Office of Policy at ONC, to join her in responding to audience members’ questions and queries during the second part of the program, which was billed as a “Listening Session.”
In her opening remarks, CMS’s Mugge said, “Why did CMS and ONC [staffers] spend the better part of last year locked in our offices, writing these proposed rules? CMS has taken a very active approach to interoperability and patient access to their health information.” And, she noted that, though, “HIPAA [the Health Insurance Portability and Accountability Act of 1996] did say that a patients should have access to their health information. You can blame data-blocking, you can blame your EHR [electronic health record] vendor,” and other players could be blamed. But, she said, “ In reality, the data’s just not flowing. Just thinking about how we use technology in our daily lives. When I lose my phone in my bag, I can ping my phone from my watch, and then use my phone to find my headphones. There’s similar convenience for consumers with banking. That’s what consumer technology is like. And yet when my son was discharged from the hospital, there was no care coordination, no follow-up, except for a couple of pieces of paper handed out. I was recently sent a note saying I needed to get some x-rays over to my primary care physician. And they said they could fax them, but the care quality wouldn’t be good. But we can’t email them. So I say to them, you can text me, but you cannot get my x-rays from suite 103 to suite 101, in their own building? And that was the case.”
In short, Mugge said, “This fractured healthcare system is providing challenges and stifling innovation.”
Speaking of CMS specifically, she said, “We put together this rule to make sure we were using the levers available to us to further interoperability. And I want to stress that, in addition to being a real step forward, this is just a first step” for CMS—and for ONC, with regard to its rule—in moving things forward around interoperability on behalf of healthcare consumers.
Mugge noted five key elements in the proposed rule, around health plans. First, all health plans that participate in Medicare Advantage, in the federal exchanges, in CHIP plans, etc., will have to provide patient access to data through APIs (application programing interfaces); second, health plans will need to share their provider directories through open-access APIs. QHPs (qualified health plans)—those that participate in the health insurance exchanges—are already doing so, she noted. Health plans will also be required to provide any information that a patient requests that involves health information from that patient’s prior insurer. For example, she said, “If I were on Health Plan A this year and had been on Health Plan B last year, I could tell Health Plan A to get my data for me from Health Plan B. We propose that this will go up to five years back. All data will have to be combined by my current payer, so I’ll have five years of my health history, including treatment history, medications, and past providers. This is critical for patients trying to bring their health information with them as they navigate the healthcare system. In addition, plans will have to join a trust network in order to facilitate the exchange of data; and, all states would be required to exchange beneficiary data and enrollment data with CMS, for dual-eligibles—individuals eligible for both Medicare and Medicaid coverage. “Currently, it can be as infrequently as once a month” that the plans serving dual-eligible recipients do so, she said. “What we find is that you can lose accurate information for nearly 30 days. To improve their experience and billing processes… states have to send that information daily.”
As for providers, Mugge said, “We propose to publicly post the names of providers who don’t successfully fulfill attestation statements. There will be three statements to attest to—and if a provider says no to any of the three, we’ll report them on our website. This is more of a signal than anything else that we are taking a hard stance on information-blocking. This data does not belong to anyone but the patient. And ONC has done an excellent job in establishing some rules. We want to demonstrate that all of HHS is doing that, so CMS is doing that.” What’s more, she noted, the proposed rule includes “a proposal to require physicians and providers to enter their direct address information into our NPPES provider directory”—the National Plan & Provider Enumeration System Provider Directory from the Department of Health and Human Services. “These directories only work if they provide their information in it. We’ll publicize the names of those providers who don’t.”
Further, Mugge said, “We are now proposing to require that hospitals, as a condition of Medicare participation, send electronic notifications at admission, discharge, and transfer of patients. We want to ensure there’s care coordination with the facility they’re being sent to or the care team. We also have two RFIs,” she added, referring to requests for information, “one on patient matching, requesting information from the public on how HHS as a whole can encourage patient-matching and information, and a second on promoting post-acute care data-sharing.
Through that data-sharing initiative, Mugge said, “Providers will have easy access to their patients’ data, and more background information on patient data. This is really a first phase for proposals for providers. We are also looking at other potential RFIs and policy levels to find ways to further promote clinician sharing of data.”
Mugge and the other CMS and ONC officials then proceeded to respond to a variety of questions from session attendees on the proposed rules.