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CMS Shares Plans to Enable Interoperability, Value-Based Care

CMS Administrator Seema Verma outlined several initiatives aimed at advancing interoperability to support value-based care at HIMSS18.

CMS planned initiatives to improve interoperability and value-based care.

Source: Thinkstock

By Kate Monica

- In remarks at the HIMSS18 conference in Las Vegas, CMS Administrator Seema Verma detailed several of the federal agency’s plans to improve interoperability and health data exchange in support of the value-based care system.

CMS primarily intends to enable value-based care by ensuring patients have control of their own health data, she explained.

“Let me be clear, we will not achieve value-based care until we put the patient at the center of our healthcare system,” said Verma. “Until patients can make their own decisions based on quality and value, health care costs will continue to grow at an unsustainable rate.”

At the current rate of healthcare-related spending, one in every five dollars spent in the US will go toward the healthcare industry by 2026, she posited.  Reducing duplicate tests and unnecessary medical services by facilitating the seamless flow of health information will help to cut costs for both healthcare organizations and patients.

The slog toward enabling a digitized healthcare system where providers have easy access to patient lab test results, diagnoses, medical histories, and other types of health data is well underway.Verma noted healthcare organizations nationwide have made progress related to EHR adoption, EHR use, and health data exchange. However, information blocking still poses a barrier to seamless interoperability.

READ MORE: CMS Modifies E/M EHR Clinical Documentation Requirements

“Despite this progress, it is extremely rare for different provider systems to be able to share data,” stated Verma. “In most cases there is not yet a business case for doing that – it’s in the financial interest of the provider systems to hold on to the data for their patients.”

Lack of patient health data access can lead to duplicate testing and unnecessary treatments, which stunts progress toward a value-based care system and increases costs for hospitals and health systems. Lack of EHR usability has also slowed the transition to a value-based care system.

“Providers also continue to find it difficult and burdensome to use EHRs,” Verma noted. “They talk about how they are still using faxes to send and receive patient data.”

“In the era of artificial intelligence, machine learning and precision medicine, fax machines continue to be the go to technology for providers transmitting health information,” she emphasized.

Verma admitted some stagnation in health data access and exchange is due to outdated CMS regulations — many of which were designed to suit a healthcare system using paper-based records.

READ MORE: CMS to Prioritize Health IT Innovation, Regulatory Relief

“In many ways, EHRs have merely replaced paper silos with electronic ones, while providers, and the patients they serve, still have difficulty obtaining health records,” she said. “For the fortunate few who do ultimately obtain their records, the information is often incomplete, and not always digital or understandable.”

The recently announced MyHealthEData initiative aims to ensure patients have control over their complete EHRs and are able to share their health data with any provider or healthcare organization they choose.

The Trump Administration initiative will assist in developing a patient-centered healthcare system in which patients are part of the clinical decision-making process. MyHealthEData could have far-reaching implications for all aspects of healthcare that require the use or collection of patient health data.

 “MyHealthEData will unleash data to trigger innovation, and advance research to cure diseases, and provide more evidence-based treatment guidelines that ultimately will drive down costs and improve health outcomes,” said Verma.

“Seventy-eight percent of doctors and 96 percent of hospitals now use EHRs,” Verma pointed out. “Physicians and patients have widespread access to the Internet and nearly everyone has a smartphone, providing many access points for viewing healthcare data securely.”

READ MORE: CMS Launches New Quality Payment Program Data Submission System

In addition to the MyHealthEData announcement, Verma also explained CMS plans to redesign the EHR Incentive Programs.

“CMS will be announcing a complete overhaul of the Meaningful Use program for hospitals, and the Advancing Care Information performance category of the Quality Payment Program,” said Verma.

“Our new direction will not only reduce time and costs, but will also be laser focused on increased interoperability and giving patients access to their data across all of our programs,” she continued.

Verma emphasized CMS plans to take a more aggressive stance toward preventing information blocking in the future. 

“It’s not acceptable to limit patient records or to prevent them and their doctor from seeing their complete history outside of a particular healthcare system,” Verma maintained.

CMS will also continue to reduce regulatory burden for providers, Verma added. Redesigning EHR clinical documentation requirements of Evaluation and Management (E/M) codes is one way CMS intends to reduce provider burden associated with federal regulations.  

“These are the codes that doctors use to bill Medicare for patient visits,” clarified Verma. “And the billing requirements are outdated, so we will be updating and streamlining them so that doctors can spend less time using their EHRs, and more time with their patients.”

Verma also discussed Blue Button 2.0, which is a standards-based API. Blue Button 2.0 is intended to enable Medicare beneficiaries to connect and share their claims data with apps, services, and research programs of their choosing.

Taken together, these efforts to streamline federal regulation, promote health IT innovation, improve health data exchange, and enable patient-centered care will help advance the healthcare industry toward its goal of achieving a value-based care system.

“For those in the healthcare industry that are already working to make health records safe, secure, easily accessible, and easily understandable to patients, we give you our full support and we applaud your efforts,” said Verma. “And we will work with you to continue on this path.”



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