CMS Interoperability and Patient Access Final Rule: Is That Actually Going into Place for Payers?

Interoperability and patient access to their health data have been a point of focus in healthcare legislation lately. This is largely because it’s been proven that continuity of care improves patient health outcomes and continuity of care is easier to achieve when everyone who is involved in a patient’s care has the same information. Let’s look at the CMS Interoperability and Patient Access Final Rule and how it will impact the healthcare industry moving forward.

What is the CMS Interoperability and Patient Access Final Rule?

The Interoperability and Patient Access Final Rule gives patients access to their health information in a way they are best able to use it, when they need it most. When patients are unable to seamlessly access their health information due to limited ability for data exchange, the outcome is higher costs and poor patient care leading to poor health outcomes. The goal of the Interoperability and Patient Access final rule is to put policies in place that eliminate the barriers that prevent patients from having access to their health information, improve interoperability and enable innovation, all while reducing the burden on providers and payers. Patients and their providers will be able to be better informed, leading to better care and improved outcomes, as well as reduced costs.

This rule is part of the MyHealthEData initiative, which works to ensure that patients can not only receive a copy of their entire health record, but also share that data with whomever they wish, putting the patient at the very center of their own healthcare. In order to accomplish this, the Interoperability and Patient Access final rule was created in order to drive interoperability and increase patient access to health information by using CMS authority to regulate Medicare Advantage, Medicaid, CHIP, and Qualified Health Plans issued on the Federally-facilitated Exchanges on requirements that make patient data more available. While patients will be affected by this final rule in that they will have greater access to their health data than ever before, and providers are affected in that they need to make sure they’re doing all they can to enable this data availability, the entity most affected by this rule is that of CMS-regulated payers.

What are the requirements of the Interoperability and Patient Access Final Rule?

There are a number of policies highlighted in this Final Rule, all of which are meant to increase interoperability and provide greater access to health information. These policies are as follows:

• Creation of a Patient Access API: CMS-regulated payers are required to establish and maintain a secure HL7 FHIR API that will allow patients to have easy access to their claims and encounter information. This must be in place beginning January 1, 2021.
• Provider Directory API: CMS-regulated payers are required to create a publicly available directory of provider information through a standards-based API in order to help patients find providers, and clinicians more easily coordinate on patient care. This must be implemented by January 1, 2021.
• Payer-to-Payer Data Exchange: CMS-regulated payers are required, at the patient’s request, to exchange the USCDI version 1 data set for that patient so that the patient can take their information with them when they move to a new payer. This is meant to make care more efficient by aiding in better informed decision-making. This data exchange mechanism must be in place by January 1, 2021.
• Public Reporting and Information Blocking: CMS will publicly report on any providers, hospitals, and critical access hospitals that may have taken part in information blocking according to their attestation on certain requirements of the Promoting Interoperability Program. This reporting will begin in late 2020 based on data collected for the 2019 performance year, and is meant to allow patients to actively choose providers who are more committed to interoperability and ease of patient access to their health information.
• Digital Contact Information: CMS will publicly report any providers who fail to list or update their digital contact information in the National Plan and Provider Enumeration System (NPPES) beginning in late 2020. The goal with this is to, again, allow patients to see which providers are allowing barriers to stand in the way of greater interoperability so that they can actively choose their care team in a way that supports access to patient health data.
• Admission, Discharge, and Transfer Event Notifications: CMS is going to be requiring hospitals to send notification of a patient’s admission, transfer, or discharge from care to their provider in order to allow for a more timely follow up. This will begin 12 months after the publication of this rule.

Most of these policies apply to CMS-regulated payers, with most of the actions required falling into those same payers’ responsibility, however it’s important that providers are aware of each of these pieces. It also should be noted that the Public Reporting and Information Blocking and the Digital Contact Information pieces do impact providers to a greater extent as they will need to ensure that they are not engaging in information blocking. Coupled with this, they’ll need to ensure their correct digital contact information is on file with NPPES.

Does this affect EMR companies?

At this point, there doesn’t seem to be anything about this rule that would impact EMRs. Again, much of what is contained in the CMS Interoperability and Patient Access Final Rule requires action on the part of CMS-regulated payers. Any action that’s necessary on behalf of providers is really in line with what they’re already doing for other quality reporting programs and ideally their EMR should already support those tasks.

In the healthcare field it’s natural to feel a little nervous whenever the phrase “final rule” is mentioned because that usually means there are some new regulations to get up to speed on, but with this particular final rule, it’s really just more something to be aware of than anything that requires significant action on the part of providers. As long as you’re being cautious about information blocking and keeping your digital contact information up-to-date, you should be in good shape. This final rule is truly to your benefit as a provider, as it should ease the burden of exchanging patient health data by moving the needle forward on interoperability in the healthcare industry as a whole.

Need more information on interoperability? Visit micromd.com or call 1-800-624-8832 to learn how MicroMD is working to aid in interoperability.