data mining

On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule introducing changes to the Medicare physician fee schedule, and soliciting comments from providers on CMS data sharing initiatives.  In the proposed rule, CMS requests comments on methods to promote the exchange of health care information between health care providers, and CMS initiatives to encourage price transparency for health care providers and suppliers.

Supporting Transitions of Care via Electronic Information Exchange

Medicare and Medicaid providers are rapidly implementing health information technology and electronic health record (EHR) systems.  While these new technologies provide many benefits, CMS acknowledges that health care providers and patients face obstacles in exchanging health information across the continuum of care, particularly when patients are discharged from a hospital.  CMS requests feedback from stakeholders on ways to use CMS health and safety standards, such as the Medicare Conditions of Participation, to advance the electronic exchange of information that supports the transition of care between hospitals and community providers.

In the proposed rule, CMS requests feedback about whether new requirements for the interoperability and electronic exchange of health information are necessary, a reasonable implementation timeframe for compliance with new interoperability requirements, and whether such requirements would help improve patient care.  CMS has also solicited comments on the operational considerations, legal restraints, or other barriers that providers and suppliers would face in implementing these initiatives.  CMS welcomes comments from the public on how to best accomplish its goal of fully interoperable health information technology and EHR systems for Medicare and Medicaid providers and suppliers.

Improving Price Transparency

CMS has also requested public comment from providers and suppliers on improving consumer access to information about potential financial liability for health care services.  Over the past several years, CMS has engaged in various efforts to require providers and suppliers to make pricing information on their “standard charges” available to the public. Most recently, the proposed rule for the Fiscal Year 2019 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals requires hospitals make their standard charges available online.  CMS has requested public comment on how to define “standard charges” for these types of public reporting purposes.  CMS seeks feedback on whether providers and suppliers should be required to inform patients of their out-of-pocket costs for a service prior to performing the service, and how providers and suppliers should engage in other CMS price transparency initiatives.

The Impact of EHR Interoperability and Price Transparency Requirements

CMS EHR interoperability requirements have the potential to impose additional regulatory obligations on Medicare and Medicaid providers, and may result in significant investment in technology upgrades.  The price transparency disclosure obligations may also present unique financial challenges for hospitals and other health care providers.  Comments on the requests for information are due on September 10, 2018.

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