In early 2020, the 21st Century Cures Act rule and the Patient Access and Interoperability rule were published, making big changes to how providers and payers have to handle health information. More changes came in late 2020 with the final 2021 Physician Fee Schedule/Quality Payment Program Rule. These rules affect the way health information is transmitted, shared, and kept secure, and they have a real impact on Caravan Health ACOs. There continue to be persistent barriers around the exchange of information, extracting or inputting health information in a standardized format, and access to health information between all parties that need access. These combined rules seek to address the need for data standardization that has long been the largest barrier to interoperability.

This blog post walks through the new requirements, explains how they work, and what they mean for your practice. 

New Rules and Requirements: 
The 21st Century Cures Act rule is intended to provide secure access to certain health information for both patients and providers. It provides guidance in three main areas: information blocking, updates to the certified electronic health record technology (CEHRT), and API and other technical specifications for vendors. The rule regulates three main actors in this space: HIT vendors, health care providers, and health information exchanges. 

Much of the rule is requirements for IT vendors, including technical specifications for CEHRT. In conjunction with the CMS rules, they intertwine to implement larger standards. The rule also states that Application Programming Interfaces (APIs), technology that allows systems to communicate, must meet fast healthcare interoperability resources (FHIR) standards for data exchange. The purpose of these new standards is to encourage innovation and new applications to give consumers more choices in how they access health information. 

The Patient Access and Interoperability Rule lets patients take more ownership of their electronic health information (EHI) and share with their health plan and health providers. A regionalized system of data brokers will assist in the exchange of this information. The rule includes conditions of participation including sending admission, discharge, and transfer (ADT) notifications electronically. Patients must be provided access to their health information by all actors, including additional payers regulated by CMS, health providers, and service vendors. This rule also requires a centralized directory of provider electronic addresses for data exchange to be published by the National Plan & Provider Enumeration System (NPPES). As with most requirements in this rule, this is intended to promote interoperability.

The final 2021 CMS Quality Payment Program/Physician Fee Schedule Final Rule 2021 also made important changes to treatment of health information. The rule updated requirements for CEHRT and information blocking. In addition, the rule makes important changes to MIPS promoting interoperability measures, including patient access to health information patient portal measure, sending and receiving summaries of care, adding a new health information exchange alternative measure, and registry reporting. 

More about the Health Information Exchange
The addition of the Health Information Exchange measure to the MIPS Promoting Interoperability measure set is good news for Caravan Health clients. Our clients can use the bidirectional attestation optional measure to score significantly better in years past. There are important requirements for clients to know about. The attestation statement requires the HIE must be bidirectional for patient referrals and exchange with disparate EHRs.

The HIE attestation measure may seem insignificant, however, the ROI is already visible as we are seeing Caravan Health average MIPS promoting interoperability scores of self-reported performance data at an average estimated 86 versus scores from 2019 which were 73.5. The difference in MIPS points is more likely to position our ACO’s to exceed the exceptional performance threshold, yielding higher MIPS adjustments. Not utilizing and leveraging an HIE as a MIPS participant can be clearly seen as leaving dollars on the table and emphasizing the importance of health information sharing to see whole patient longitudinal stories. Our findings initially are that many health systems have an HIE connection and have not been leveraging them. This incentive will help to move the standardization of data exchange. 
More about Information Blocking 
Information blocking is when Health IT developers or health providers inappropriately interfere with access or exchange of electronic health information. This could happen because providers restrict access to EHR information from patients, make EHI burdensome to access, or refuse to share with competing providers. 
“Sometimes providers inadvertently block access to information by not understanding how the patient portal works, or not having optimized workflows for sending and receiving summaries of care,” advises Penny Morris, Caravan’s Interoperability Program Manager. “These activities are not considered information blocking because the rule is based on intent, and therefore not regulated. Practices should also know that behavioral health notes are excluded from the requirement to release EHI to patients.” 

What does this all mean for Caravan Health clients?

  • There will be penalties for those that don’t comply: Penalty amounts are not determined yet, but HHS intends to impose penalties for non-compliance.
  • These are intent-based regulations- When considering compliance, HHS will consider if the information blocking was intentional on a large scale, or just accidental. This is mostly the concern of larger vendor organizations for EHR platforms.
  • Keep technology up-to-date. ACO members need to update EHRs with all necessary and recommended upgrades and software update. 
  • Keep patients informed about their health information. Patients have the right to access their health records. 
  • Sharing of health information. Providers have an obligation to exchange Health Information Electronically when requested by patients, payers, or other providers to continue to promote delivery of the right care at the right time in the right place. 
  • Update NPPES with Direct Addresses. Keeping this information current is the best way to comply with requirements.

Recent Resources

CMS Actions in Response to the COVID-19 Public Health Emergency

The Centers for Medicare and Medicaid Services just issued a lengthy set of policy changes to address the growing COVID-19 public health emergency (PHE). These changes will help hospitals and health providers to respond to the crisis more quickly and safely, including many more options for telehealth in Medicare.

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Stop Standing Still: How to Get Started in a High-Performing Caravan Health ACO

Tuesday, September 24 at 9:00am PT / 12:00pm ET

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10 Reasons ACOs Can Fail

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NEWS: Signify Health Completes Acquisition of Caravan Health

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