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CMS Health Data Exchange Goals for Quality Payment Program

As part of its efforts tied to the Quality Payment Program, the federal agency has listed increased health data exchange among its strategic objectives.

By Kyle Murphy, PhD

A new year begins with the kickoff of the Quality Payment Program and with it a commitment by the Centers for Medicare & Medicaid Services (CMS) to achieve six strategic objectives, one of which focuses on its own health data exchange improvements.

“Achievement of these strategic objectives will put us on a better path for Medicare in this country,” the federal agency states in a recent educational resource. “This evolution will begin to reduce the burden on clinicians, while also laying the groundwork for connected care, improved innovation, and intuitive health care technology.”

The emphasis on an evolving performance program echoes previous statements by federal officials that its approach Quality Payment Program objectives and requirements will be iterative in nature to help providers transition successfully.

The first performance period for the inaugural year of the Quality Payment Program — which comprises both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) — began on January 1. These strategic objectives are part of the federal agency’s own work to learn alongside Quality Payment Program participants.

“We have developed Strategic Objectives for the Quality Payment Program to guide our future rulemaking in order to design, implement and evolve a Quality Payment Program that aims to improve health outcomes, promote smarter spending, minimize burden of participation, and provide fairness and transparency in operations,” CMS observes.

Among the six objectives is a commitment on the part of CMS to ensure that healthcare organizations and providers have access to its stores of administrative and clinical data.

“CMS has administrative and clinical data that is highly valued by the clinician and wider stakeholder community. The information is only valuable if it is accessible, accurate, timely, and inclusive of the elements that matter the most to clinicians,” the resource reads.

“Much of the data in the immediate future,” it continues, “will also be in the form of electronic health information that informs care and brings the most recent scientific evidence to the point of care in an effort to bolster clinical decision-making. Vendors and physicians will be important partners in ensuring that such information is available in actionable formats and in a timely manner."

Along similar lines, CMS is tasking itself with promoting understanding of and participation in the Quality Payment Program through various outreach mechanisms.

“In addition to raising awareness that change is occurring, we will work to engage in a learning process with clinicians, the technology industry, private payers, and beneficiaries where these groups may voice opinions and suggestions to help collaboratively drive the goals of the Quality Payment Program,” the federal agency explains. “We will also work to set expectations that this will be an iterative process and, while change will not happen overnight, we are committed to continuing our work to improve how Medicare pays for quality and value, instead of the quantity of services.”

The message from CMS is clear. The federal agency is looking to avoid the mistakes made in previous performance programs relative to provider and industry feedback.

The remaining objectives focus on a range of topics:

• Improve beneficiary outcomes and engage patients through patient-centered Advanced APM and Merit-based Incentive Payment System (MIPS) policies.

• Enhance clinician experience through flexible and transparent program design and interactions with easy-to-use program tools.

• Increase the availability and adoption of robust Advanced APMs.

• Ensure operational excellence in program implementation and ongoing development.

As for eligible clinicians, the Quality Payment Program and its two pathways include requirements aimed at improvements to care coordination and patient outcome. For example, MIPS-eligible providers must report on five measures for a minimum of 90 days to avoid payment adjustments, two of which will test the health data exchange and interoperability capabilities of eligible clinicians.

Dig Deeper:

Solutions for Addressing Health Information Exchange Challenges
Breakdown of Health IT Interoperability Standards, Organizations




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