CMS floats proposal tying medical records sharing to Medicare participation

Buried underneath changes to the Meaningful Use program, a newly proposed hospital payment rule includes the possibility of more stringent federal requirements that would force providers to share data to participate in Medicare and Medicaid.

That approach, which involves revising Conditions of Participation (CoPs), would allow the Centers for Medicare & Medicaid Services to wield a far heftier regulatory stick and offer a clear-cut business case for interoperability. 

The 1,880-page rule (PDF) released by the Centers for Medicare & Medicaid Services (CMS) on Tuesday includes what the agency dubbed as an “overhaul” of the Meaningful Use program, now known as Promoting Interoperability. As part of that change, the agency shaved down number or measures hospitals are required to meet from 16 to six and revamped the program to a points-based scoring system.

CMS also wants providers to adopt 2015 Edition Certified EHRs beginning in January 2019. 

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But the rule also floats the idea of revising Medicare and Medicaid CoPs to require hospitals to share patient records electronically with other hospitals, community providers and patients "if possible."

A CMS spokesperson did not immediately respond to questions clarifying whether proposed CoP revisions would include all three data sharing scenarios.

“This is definitely a battering ram to the silos that are perceived to exist between hospitals and other hospitals, hospitals and other facilities, and hospitals and patients,” Jeff Smith, vice president of public policy for the American Medical Informatics Association (AMIA), said.

While providers would absorb a 3% downward payment adjustment for failing to adhere to the measures within the Promoting Interoperability program, revising CoPs would raise the stakes by dictating whether hospitals could participate in the federal programs.

“If you don’t meet [CoPs], you don’t get to play in the game called Medicare,” Smith said.

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The exact requirements of that approach are still up in the air, and CMS requested more information from stakeholders regarding possible revisions to CoPs, including specific questions about whether new requirements would help reduce information blocking, whether existing portals could satisfy such requirements and additional feedback on a reasonable timeframe for compliance.

CoP requirements are “held sacred” to providers, according to Jeff Coughlin, the senior director of federal and state affairs at HIMSS, who noted that any revisions would be “a big deal.” While there have been discussions among federal officials in the past about adopting this approach, it's not one that has been publicly addressed until now.  

“It’s a really valuable policy lever that’s been staring CMS in the face in terms of what they could do if they really wanted to make a difference,” Coughlin said.

Giving TEFCA more teeth

If CMS does decide to revise the CoPs to include elements of interoperability, it could also give more weight to the Trusted Exchange Framework and Common Agreement (TEFCA), guidance that the Office of the National Coordinator for Health IT is currently finalizing.

Officials have said that framework will be voluntary but restructuring Medicare participation requirements could pressure providers by tying participation to CoPs. Theoretically, CMS could say participation in TEFCA would meet the requirements of any revised CoPs.

“This is how you make TEFCA a number one priority for hospitals,” Smith said.

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Coughlin, who has suggested tying TEFCA to the forthcoming information blocking rule to give the framework more teeth, wouldn’t comment on whether he would support an approach that linked TEFCA to Medicare participation regulations, noting that HIMSS officials hadn’t fully discussed that option.

But he did say it was a potentially valuable lever the agency could use to drive more engagement with TEFCA.

“We want to try and utilize all available means to facilitate better data exchange,” he said.