Pew offers CMS advice to boost inpatient rule interoperability

Les Masterson

June 25, 2018

Dive Brief:

• The Pew Charitable Trusts is recommending changes to CMS for its 2019 proposed Hospital Inpatient Prospective Payment System, saying the proposed rule needs improvement in the areas of health information exchange, provider-to-patient exchange, public health and clinical data exchange, request for information and release of claims data.
• The organization said the agency's attempt to improve interoperability within the payment programs has three key barriers: difficulties matching health records to the correct patient, issues with getting data from health records and limitations on how to describe clinical information.
• Pew said as few as half of the attempts to match patient health records with patients are successful. Improving the match rate would enhance access to care and outcomes and lower healthcare costs. “The foundation for achieving the interoperability goals CMS has outlined in this proposed rule starts with better patient matching,” Pew said.

Dive Insight:

In announcing the proposed changes in April, CMS noted some of the changes implement statutory provisions in the 21st Century Cures Act and the Bipartisan Budget Act of 2018.

The proposals seek to promote interoperability and Pew said they will also allow patients to get health data to inform care decisions.

The group said the changes are an “important step in ensuring that patients and clinicians have the data they need to inform care decision — especially once additional progress is made on patient matching, effective use of (application programming interfaces) and adoption of clinical data standards.”

CMS Administrator Seema Verma has proposed initiatives to boost interoperability, such as giving patients more control over their health record. This work includes overhauling Medicare’s personal health record system, an effort called Blue Button 2.0.

A recent Health Affairs analysis found that hospitals are improving interoperability. However, those advances are mostly through transmitting information and not on usability. Less than one-fifth (18.7%) of hospitals said they often use patient data from outside providers to inform patient care decisions, suggesting interoperability in patient care has a long way to go.

One possible tool to improve interoperability is blockchain. A 2017 Black Book Market Research survey of payers, medical group managers and IT specialists found that 70% see the potential of how blockchain could address connectivity issues and data sharing.

The Leapfrog Group recently announced it opposes the CMS proposed rule, and calling it a “significant threat to the transparency of the safety of U.S. hospitals.” The group, which advocates for hospital safety and transparency, said the proposal removing measures from the Inpatient Quality Reporting Program will hurt transparency and reduce hospital penalties for errors and infections.

https://www.healthcaredive.com/news/pew-offers-cms-advice-to-boost-inpatient-rule-interoperability/526432/