Provider, IT groups push CMS to incorporate technology into new payment models

Seema Verma speaking at press conference
AHA and HIMSS were among the associations calling for Seema Verma to build data and technology into new payment models. (whitehouse.gov)

Months after federal health officials said they want to push the Center for Medicare & Medicaid Innovation in a “new direction,” provider and health IT associations are advocating for the inclusion of health technology and data in new payment models.

Several organizations, including the American Hospital Association (AHA), the American Medical Informatics Association (AMIA) and HIMSS highlighted the need for real-time data and health informatics tools to properly execute value-based payment models.

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Their comments were submitted in response to a request for information announced by the Centers for Medicare and Medicaid Services in September following an op-ed by CMS Administrator Seema Verma in which she indicated the agency was reviewing the payment models generated through CMMI.

HIMSS specifically called on (PDF) the agency to devote more attention toward interoperability and health information exchange and the way in which various business models “impact providers’ ability, or incentive, to share patient data.” The group also called for more transparency in the industry regarding price and outcomes.

AMIA advocated (PDF) for a broader focus on optimizing data analytics and informatics tools into new payment models by beefing up the application process and providing direct funding for enhanced data capabilities.

“Just as clinicians are expected to use medical devices and pharmaceuticals to improve patient outcomes, so too must we expect them to leverage evidence-based informatics tools and methodologies,” the group wrote in a letter to Verma. “We recognize that evaluating implementation of informatics as an intervention is difficult, but we strongly believe it is important to take time to think through this increasingly important dimension of care delivery.”

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The American Telemedicine Association focused (PDF) on telehealth reimbursement, noting that the “fastest, easiest way to improve Medicare telehealth is to allow states to develop and operate combined and coordinated Medicare and Medicaid telehealth.” The group also urged CMMI to test a model in which licensed professionals could practice telehealth across state lines for beneficiaries of government health programs.

Amid a slew of recommendations that touched on telehealth reimbursement social determinants of health and timely access to patient data, the AHA also encouraged (PDF) CMMI to “prioritize models that test new technology approaches,” allowing providers to understand the benefits of certain tools, like telehealth, before incorporating them into federal regulations.

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That suggestion was part of AHA’s ongoing effort to cancel Meaningful Use Stage 3. The group argued that specific technology requirements built into Stage 3—such as patient-generated data and the use of application programming interfaces (APIs)—should be tested through CMMI models before they are incorporated into reimbursement requirements.

“A demonstration permitting the use of the technologies will reveal their true benefits for patients and providers and would spur their adoption where the technology used makes the most sense and is reasonable and necessary, without heavy-handed regulatory action,” AHA wrote.