The demand for enhanced sharing and accessibility of health information across health plans and care providers continues to grow. In its recent Medicare Learning Network listening session, the Centers for Medicare & Medicaid Services (CMS) outlined the new Interoperability and Patient Access proposed rule. The proposed rule represents the first phase of policies being developed by CMS to improve patient access to information and enhanced interoperability among providers, payers, and related industry members. The rule is far-reaching, applying to all of the entities that CMS regulates, and was developed as a cross-agency federal department effort alongside the Office of the National Coordinator (ONC) rule released on the same day.

If you were unaware of this Medicare Learning Network listening session or unable to attend, below is a brief overview of the provisions and a list of the unique features discussed.

Proposals for Health Plans and Payers

1. A requirement for health plans to build an openly accessible Application Programming Interface (API) that allows patients to access their healthcare information, as well as the ability to share that information with other caregivers and providers.
2. Free and public availability of provider directories using an open access API to help enrolled beneficiaries and perspective enrollees review in-network providers, and to assist clinicians with recommending in-network referrals.
3. The Payer-To-Payer Data Exchange Proposal takes payer and health plan information exchange a step further by empowering patients with the ability to request information exchange between health plans. The health plans would then be required to accumulate and deliver up to 5 years’ worth of that patient’s health information for them to access through the API mentioned in the previous proposal.
4. Health plans would be required to join a trust network to facilitate the exchange of information between health plans, providers, and health systems.
5. State Medicaid Agencies would be required to send data to CMS on a daily basis, ensuring the patients enrolled in Medicare and Medicaid plans do not experience any lack in coordination of benefits that could results in confusion and/or unwarranted billing.

Proposals for Providers

1. Clinicians and providers must attest that they are not knowingly or willingly participating in the practice of information blocking. Providers that are unable to affirm that they are not information blocking will be publicly reported on the CMS website to root out providers who are limiting the flow of information and patient care.
2. Providers are expected to put their information into the NPPES database to encourage the flow of information between providers, help them to find one another in the digital atmosphere, and exchange information. The rule proposes that providers who do not put their digital contact information into NPPES by certain date will have their names publicly reported.
3. As a condition of participation in Medicare, hospitals will be required to send providers an electronic notification when a patient is admitted, discharged, or transferred to another provider. This serves to help improve the continuity of care and overall patient experience.

If you aren’t familiar with Quanum EHR Direct Exchange, we encourage you to look into it as a way to complete the Promoting Interoperability measures in 2019. Direct Exchange makes it easy to share patient health information among physicians, hospitals, pharmacies, and other providers in a secure, clinical messaging format that is compliant with HIPAA regulations.

As part of the Direct Trust Network with Direct Exchange, you can

• Exchange secure information including chart content, lab results, patient history, and medication information, with other physicians
• Share patient electronic health records across disparate systems
• Help improve overall coordination and continuity of care

To learn more about Quanum EHR and Direct Exchange, contact your customer support representative or call us at 1.888.835.3409.