- Hospitals need to increase health data exchange and communication with primary care providers (PCPs) to improve care coordination, boost patient health outcomes, and reduce hospital readmission rates, according to former CMS official and current Aledade Chief Administrative Officer Sean Cavanaugh.
“When I was at CMS, we created a code called Transitional Care Management because there was evidence when a patient gets discharged from the hospital, if they’re very soon thereafter linked with their primary care physician, there’s evidence they’re less likely to be re-admitted, better health outcomes, lower costs,” said Cavanaugh at a recent House and Ways subcommittee hearing.
“We created a code so the physician can bill for that type of management,” continued Cavanaugh. “Then we saw that the code didn’t get used much.”
When CMS inquired about why the code wasn’t being used, Cavanaugh testified that PCPs stated they did not know when their patient was being discharged from the hospital. As a result, PCPs could not bill for transitional care management services.
This indicated to CMS that rates of health data exchange — particularly of admission, discharge, and transfer (ADT) data — were lacking between hospitals and PCPs.
“Hospitals that aren’t willing to notify PCPs when patients have been discharged from the hospital are a problem,” said Cavanaugh.
While the advent of the health information exchange (HIE) has helped to boost rates of ADT data exchange, some hospitals are still reluctant to share information. This reluctance largely stems from problems with information blocking.
Some hospitals and health systems view patient EHRs and other health information as proprietary information, Cavanaugh explained. These healthcare organizations hoard data as a way to ensure patients do not seek care at other healthcare facilities or with other providers.
“It’s appalling to me that some hospitals say, ‘no, we see that data as a competitive advantage and we’re not going to share it with you,’” said Cavanaugh.
As a way to promote the exchange of ADT data, Cavanaugh recommended that ADT notification sharing become part of the Medicare Conditions of Participation.
CMS recently issued a request for information (RFI) about how to revise the Conditions of Participation to promote interoperability and increase health data exchange between hospitals and providers. The federal agency issued the RFI along with the 2019 CMS Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCHPPS) proposed rule.
The RFI from CMS “seemed to indicate that they were entertaining the idea that sharing information about hospital discharges and ED visits would be a condition of participation in Medicare,” testified Cavanaugh.
Leveraging federal policy to promote ADT notification sharing could provide incentive for healthcare organizations to reduce information blocking and put patients first.
“Thanks to Congress, 95 percent of American hospitals have certified EHR technology,” said Cavanaugh. “They can do this — it’s all a question of will.”
“And as I said it’s a question of whether they’re willing to put the beneficiaries first,” he added.
Many members of HIE leadership are enthusiastic proponents of ADT notification use.
Last year, Utah Health Information Network (UHIN) President and CEO Teresa Rivera penned an editorial advocating for increased ADT notification use. Rivera emphasized that ADT notification use can improve care coordination and reduce hospital readmissions — which can save hospitals money.
UHIN has been enabling ADT notification use between healthcare organizations for 10 years.
“This level of care coordination quite literally saves both lives and money,” said Rivera.
Promoting health data exchange through federal policy may help to improve patient health outcomes and cut hospital costs.