In March 2018, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced a series of planned reforms designed to reduce regulatory burden, increase electronic health record (EHR) interoperability, and advance access to medical records for patients.
Administrator Verma announced CMS is planning on overhauling its meaningful use requirements, in response to years of provider complaints that the program is too burdensome and difficult to implement. CMS’s stated goal is to reduce time and compliance costs associated with the program.
The agency’s moves come just weeks after President Donald Trump signed a funding bill that includes measures to ease meaningful use requirements and expand telehealth access for Medicare beneficiaries. The meaningful use bill could make meeting EHR meaningful use requirements easier because those requirements no longer would become stricter over time.
The CMS administrator described the path to a digitized healthcare system wherein providers have easy access to patient lab test results, diagnoses, medical histories, and other types of health data as a “slog.”
Verma noted that 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.
“Providers also continue to find it difficult and burdensome to use EHRs,” Verma noted. “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. For the fortunate few who do ultimately obtain their records, the information is often incomplete, and not always digital or understandable.”
“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,” Verma said in remarks published on the CMS website. “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.”
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.
In the announcement in a speech on March 6, Verma also unveiled two new initiatives. The first initiative, MyHealthEData, is intended to make it easier for patients to obtain and share their medical records.
The 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 asserts that the initiative will assist in developing a patient-centered healthcare system in which patients are part of the clinical decision-making process. “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,” Verma said.
“It is extremely rare for different provider systems to be able to share data,” Verma said. “In most cases … it’s in the financial interest of the provider systems to hold on to the data for their patients.”
Verma also unveiled Medicare’s Blue Button 2.0. The initiative is a web application that provides a secure way for Medicare beneficiaries to access and share their personal health data in a universal digital format. The application will allow patients to access and share their healthcare information, previous prescriptions, treatments, and procedures with a new doctor; such sharing can reduce duplication in testing and provide continuity of care.
More than 100 organizations, as of late March, including some of the most notable names in technological innovation, had signed on to use Medicare’s Blue Button 2.0 to develop applications that will provide innovative new tools to help these patients manage their health.
In her remarks, Administrator Verma specifically called on all healthcare insurers to follow CMS’s lead and give patients access to their claims data in a digital format.
“CMS serves more than 130 million beneficiaries through our programs, which means we are uniquely positioned to transform how important healthcare data is shared between patients and their doctors,” she said. “Today, we are calling on private health plans to join us in sharing their data with patients because enabling patients to control their Medicare data so that they can quickly obtain and share it is critical to creating more patient empowerment.”
In her announcement, Verma stated that 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.
Reducing duplicate tests and unnecessary medical services by facilitating the seamless flow of health information is key to cutting costs for both healthcare organizations and patients. Lack of patient health data access can lead to duplicate testing and unnecessary treatments, stunting progress toward a value-based care system and increasing costs for hospitals and health systems. Lack of EHR usability has also slowed the transition to a value-based care system.
As part of CMS’ announced plan to reduce the regulatory burden for providers, CMS plans to redesign EHR clinical documentation requirements of Evaluation and Management (E/M) codes. “These are the codes that doctors use to bill Medicare for patient visits,” Verma said. “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.”
Taken together, the Trump administration maintains 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.
In a March 19 Fortune magazine editorial, Joe Biden, 47th US Vice President and co-chair of the Biden Cancer Initiative, directly responds to these announcements.
“While I agree with the administration goals stated [here], these health data issues are not new and we must all get serious and specific about the details to take action in the near term,” Biden writes in “To Save and Improve Lives Using Data, Details Matter.”
“We have now had nearly a decade to examine the consequences of how the electronic health record systems have been deployed,” he said. “The industry has had ample opportunity to voluntarily address the issues of interoperability and putting data in patients’ hands, and they have not done so. Now is the time to do something about the data siloes they have created—to improve health and extend lives.”
Biden recommended that health care providers be required to provide patients with their full medical record in electronic form within 24 hours of a request, and that those providers who do not comply should be held accountable by the U.S. Department of Health and Human Services for data-blocking as outlined in the 21st Century Cures Act. He also recommended that the Center for Medicare and Medicaid Innovation invest in a patient data system that brings data from disparate formats and care providers into a uniform patient data portal to help reduce confusion and duplication and eliminate unnecessary procedures.
Administrator Verma said CMS has implemented laws regarding information blocking—a practice in which providers prevent patients from getting their data. Under some CMS programs, hospitals and clinicians must show they have not engaged in information blocking activities.
The administrator also highlighted other CMS plans to empower patients with data:
CMS is requiring providers to update their systems to ensure data sharing.
CMS intends to require that a patient’s data follow them after they are discharged from the hospital.
CMS is working to streamline documentation and billing requirements for providers to allow doctors to spend more time with their patients.
CMS is working to reduce the incidence of unnecessary and duplicative testing that occurs as a result of providers not sharing data.
As these reforms progress, the American Society of Nephrology will provide input to CMS and report back here on CMS’ progress.