Musings on the CMS / ONC’s 21st Century Cures Act
DALLAS, TX, March 17, 2020 – On March 9, 2020, the U.S Department of Health and Human Services (HHS) and the Office of the National Coordinator for Health Information Technology (ONC) announced the final interoperability rules on the 21st Century Cures Act. The new rules list requirements that include the Patient Access API, the Provider Directory API, ADT Event Transfer Notifications, Digital Contact Information for providers, and improving the dually eligible experience by modifying the frequency from a monthly to daily exchange. Some of these new rules will begin as early as fall of 2020, and the latest implementation must be in place by Spring 2022.
How will this ruling manifest itself in the coming months and years? What will the changes look like for patients? And what does it mean for health systems?
HSS and ONC claim that the core of the ruling is putting the patient first. The assumptions behind the rule is that giving patients more control and putting them in charge of their health care is essential to achieving better health outcomes and working toward a value-based care system. Patients need more transparency and power when it comes to their health and supplying access to their own health data is a key supportive step.
One interesting outcome that apparently represents settled law is in the area of transparency vs. privacy. For years, interoperability progress has been arrested by HIPAA violation hysteria. This new ruling makes clear that in the case of interoperability and data access, CMS and ONC have tipped the scales towards transparency. Their belief is that API data feeds are not a likely source of data privacy breaches. Score one for modern technology.
What does it look like for patients?
The new rule includes a stipulation requiring that health systems and doctors provide their patients with software access points to access their medical records, and download them to their smartphone, should they choose. We believe this requirement supports putting the patient first. Ease of access to patients’ own data is common sense. The modern age we live in provides opportunities to deploy or build out applications that can be accessed from smart devices.
Additionally, patients can expect greater transparency in how they book and receive care. The ruling will bring the clearness patients have been longing for, in terms of both pricing and products. The increased availability of data will assist patients in making more informed decisions that support better care, as well as provide insights on costs.
As stated in the CMS Final Rule, hospitals are required to make their standard charges available to the public under section 2718(e) of the PHSA. In addition “this final rule requires hospitals (as defined at 45 CFR 180.20) to establish, update, and make public a list of their gross charges, payer-specific negotiated charges (including the deidentified minimum and maximum negotiated charges), and discounted cash prices for all items and services online in a single digital file that is in a machine-readable format.”
Along with rules on price transparency, additional requirements to improve transparency include modified criteria for exportation of Electronic Health Information (EHI). The ruling aims to “advance the interoperability of health IT as defined in section 4003 the Cures Act, including the ‘complete access, exchange, and use of all electronically accessible health information.’”
What does it look like for health systems?
A ruling related to transparency in the March 9th release was laid down for hospitals to communicate more consistently with referring provider communications. Both of these rulings put hospitals and payors on notice that they need better data about providers:
1. By fall of 2020, hospitals will be required to send admission, discharge, and/or transfer event notifications to other healthcare facilities or providers for every patient. These notifications aim to improve care coordination by allowing the receiving provider or hospital to reach out to the patient in a timely manner and deliver appropriate follow-up care.
2. Beginning January 1st, 2021, all CMS regulated payors, including MAOs, Medicaid Fee-for-Service (FFS) programs, Medicaid entities and CHIP programs will be required to make provider directories publicly available. The reasoning is to encourage innovation by allowing third-party application developers to create programs that use this information to improve care. Whether it is helping a patient find the right provider and treatment or enabling doctors to better coordinate care.
What does this mean for Health Systems and Payors?
A serious reexamination of current provider data management approaches.
Hospitals must have up-to-date provider data in order to comply with the objective of consistent and accurate delivery of Admission, Discharge, and Transfer (ADT) alerting. Lacking accurate provider data when passing along patient notifications will make it impossible to meet the entirety of that rule.
We have said before that EHR systems – ADT software is one of many EHR modules – is a patient-centered, not provider-centric, system. EHRs need, but don’t have the facilities to manage the provider data needed to meet the rule. A new data platform is needed that manages providers which can feed the ADT system with providers’ direct address, secure email or FAX numbers – for every referring physician.
What’s more, for payors – both commercial and health system-based – to stand up a public facing provider directory, as required at the start of 2021, they need a platform that provides it with methods that ensure provider data is continuously-curated and accurate.