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CMS Proposes Publicly Identifying Information Blocking Providers

CMS will publicly identify providers who participate in information blocking.

Information blocking and health data exchange

Source: Thinkstock

By Kyle Murphy, PhD

- The Centers for Medicare & Medicaid Services (CMS) is set to get tough on “bad actors” contributing to health information blocking.

Following the announcement of the Interoperability and Patient Access Proposed Rule, CMS Administrator Seema Verma told members of the press that the federal agency would be publicly identifying providers who prevent health data sharing.

“We’re also putting an end to information blocking. The days of holding a patient’s data hostage are over,” she stated.

Our proposed rule includes a policy to publicly identify doctors, hospitals, and other healthcare providers who engage in information blocking,” Verma continued. “Simply put, we’re going to expose the bad actors who are purposefully trying to keep patients from their own information. Patient data doesn’t belong to the doctor, hospital, or electronic health record. It belongs to the patient.”

As part of a condition for receiving full Medicare reimbursement, eligible providers will have to attest whether they have participated in information blocking. The Merit-based Incentive Payment System (MIPS) will include the component.

 “There are three questions related to information blocking. If they answer yes to one of those, we will be publishing that data,” said Verma.

Under the rule, hospitals will be required to send electronic notifications to providers when patients are admitted, discharged, transitioned (otherwise known as ADT) to the hospital.

“Increasing quality and driving down costs requires an informed care team,” Verma emphasized. “Using the strongest lever we have — making it a condition of participation in Medicare — we are requiring that all hospitals must send electronic notifications to designated healthcare providers when their patients are admitted, discharged, or transferred from the hospital to improve transitions of care between medical settings [and] to increase patient safety, coordination, and improve overall care.”

Information blocking, however, isn’t limited to providers. CMS also has plans to make payers responsible for sharing data with patients.

Under the proposed rule, Medicare Advantage (MA) organizations, Medicaid managed care plans, CHIP managed care entities, and qualified health plan (QHP) issuers must enable patients to maintain access to their healthcare information as they move between plans.

“By ensuring patients have access to their information, and that information follows them on their healthcare journey, we can reduce burden, eliminate redundant procedures and testing, and give back valuable clinician time to focus on improving care coordination, and ultimately health outcomes,” the federal stated in an official factsheet.

CMS referenced Fast Healthcare Interoperability Resources and FHIR-based APIs as part of requirements for health plans. Along similar lines, these health plans would be tasked with supporting API access to published provider director data.

“Health plan provider directories help patients find in-network providers and allow healthcare professionals to locate other providers for access to medical records, referrals, transitions of care, and care coordination,” CMS explained.

“APIs ensure that up to date information for all providers is available for use by developers building tools to support beneficiaries. Because QHP issuers on the Federally Funded Exchanges are already required to make provider directory information available in a specified, machine-readable format, we are not proposing these requirements for QHP issuers at this time.”

“We propose that payers in CMS programs be able to participate in a trusted exchange network which would allow them to join any health information network they choose and be able to participate in nationwide exchange of data. This would enable the information to flow securely and privately between plans and providers throughout the healthcare system,” the federal agency wrote.

The federal agency’s work on combating information blocking falls under its great goal of growing support for MyHealthEData, the initiative CMS launched last year to improve patient data access.  

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