CMS renames 'meaningful use' to 'promoting interoperability' and changes ensue

In its latest Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System rule changes announced April 24, CMS renamed its meaningful use program again in an attempt to reflect its emphasis on achieving interoperability.

Meaningful use, which CMS changed to "advancing care information" and rolled out under the Medicare Merit-based Incentive Payment System, will now be called "promoting interoperability." To advance data-sharing in healthcare, CMS is requiring that hospitals make patients' EHRs available to them on the day they leave the hospital starting in 2019.

"We seek to ensure the healthcare system puts patients first," said Administrator Seema Verma. "Today's proposed rule demonstrates our commitment to patient access to high-quality care while removing outdated and redundant regulations on providers."

"We envision a system that rewards value over volume and where patients reap the benefits through more choices and better health outcomes," Ms. Verma added. "Secretary Azar has made such a value-based transformation in our healthcare system a top priority for HHS, and CMS is taking important, concrete steps toward achieving it."  

CMS hopes to make the program more flexible and less burdensome, in part by adding "measures that require the exchange of health information between providers and patients, and incentivize providers to make it easier for patients to obtain their medical records electronically," the announcement states. Specifically, it is replacing six measures with four:   

  • E-prescribing
  • Health information exchange
  • Provider-to-provider exchange
  • Public health and clinical data exchange

The proposed rule also underscores the requirement of using the 2015 edition of certified EHR technology to demonstrate meaningful use and thereby qualify for incentive payments as well as avoid reductions to Medicare payments. The 2015 CEHRT enables the use of application programming interfaces, which can improve the flow of information and allow patients to collect their health data from multiple providers to organize their information in a single portal, application or program, Ms. Verma added.

The program's name change, however, may not be the biggest update affecting health IT, as former ONC chief Farzad Mostashari, MD, pointed out in a tweet April 24. Buried deep in the rule change, on page 1,475, Dr. Mostashari noted that CMS proposed to use hospital conditions of participation to ensure interoperability and patient access.

"In light of the widespread adoption of EHRs along with the increasing availability of health information exchange infrastructure predominantly among hospitals, we are interested in hearing from stakeholders on how we could use the CMS health and safety standards that are required for providers and suppliers participating in the Medicare and Medicaid programs (that is, the Conditions of Participation, Conditions for Coverage and Requirements for Participation for long-term care facilities) to further advance electronic exchange of information that supports safe, effective transitions of care between hospitals and community providers," the rule states.

CMS suggested it may consider revising the current CoPs for hospitals to mandate they electronically transfer medically necessary information to another facility upon a patient transfer or discharge, require hospitals to send required discharge information to a community provider via electronic means if possible, and necessitate hospitals make certain information available to patients or a specified third-party application electronically upon request.

"This payment proposal takes important steps toward a Medicare system that puts patients in charge of their care and allows them to receive the quality and price information needed to drive competition and increase value," Health and Human Services Secretary Alex Azar said.

CMS is accepting comments on the proposed rule until June 25. "We're asking: what barriers prevent providers from informing patients of their out of pocket costs; what's needed to support greater transparency in out of pocket costs; what can be done to better inform patients about their costs; what role should providers play?" Ms. Verma tweeted. "Patient safety is our top priority, so improving our quality programs is critical," she added.

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