HIMSS19: Seema Verma says proposed information blocking rules with 2020 deadlines 'realistic'

Since Medicare Advantage and Medicare Managed Care health plans are already exchanging claims data with CMS, the proposed rule would simply open access to the patient, Centers for Medicare & Medicaid Services Administrator Seema Verma said. (YouTube)

As part of the proposed rules released by the Office of Management and Budget this week, the Trump administration has said it would give 125 million patients electronic access to their medical claims information by 2020. 

But how realistic a goal is that?

It's totally reasonable because it's already happening, Centers for Medicare & Medicaid Services Administrator Seema Verma told FierceHealthcare at the Healthcare Information and Management Sytems Society's (HIMSS) annual conference and exhibition.

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"We've already made all of our claims data available to Medicare beneficiaries on the fee-for-service program. We're essentially telling our vendors, the people that work for us: 'This is the expectation. We've done it. Now we expect the same for you.'"

In other words, she said, since Medicare Advantage and Medicare Managed Care health plans are already exchanging claims data with CMS, the proposed rule would simply open access to the patient, she said: "We're certainly seeking comment to hear from the industry, but we felt like it was a realistic expectation and we invite stakeholder input on the deadline." 

The Office of the National Coordinator for Health Information Technology unveiled its information blocking rule (PDF) on Monday, which was sent to the Office of Management and Budget for review in September. CMS also released a proposed rule (PDF) on Monday morning, which also takes aim at data blocking.

Here's what else she had to say about the rules: 

  • On enforcement: The rule, she said, proposes that providers be required to answer questions on information blocking, and if they say they participated in certain blocking activities, it would be published by CMS. "Patients would have the ability to know which providers may or may not be able to give them their healthcare data and then they can decide to take action," Verma said.
     
  • On whether the rule could lead to costs being passed on to patients: "When those standards are developed and they are standard across the entire industry, it doesn't cost more, essentially, to provide this information," Verma said. "We don't see that as an issue."
     
  • On patient matching identification: "We know we need to do more work on that," Verma said, referring to an example of mix-ups of her and a neighbor—also coincidentally named Seema Verma—and their physicians' offices. "What we put in our rule is essentially an RFI to start the discussion around that and hear from stakeholders about how the system can best address that issue." 

Verma said she sees the market moving in a way that will make consumers care. She pointed to Blue Button 2.0, which opened up data to developers, about a year ago. Since them, they've gotten 1,500 app developers and 18 apps that are live and being used.

"Once these apps are out there, you're going to create demand—a natural market—to say 'Wow, there's this app that can do XYZ,'" Verma said.

If consumers see their friends are able to get that information through an app, she said, it creates interest from other consumers.

"It creates demand for the consumer to say, 'I want to be able to pull down my data,'" Verma said. "And when they hear 'No, you're not going to be able to get your data,' that's when the patient starts to understand what information blocking is."

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