The Centers for Medicare & Medicaid Services has proposed a federal rule aimed at putting patients in the center of the U.S. healthcare system. CMS Administrator Seema Verma discussed the development in a keynote session delivered Feb. 12 at HIMSS19 in Orlando.
The Interoperability and Patient Access proposed rule “has policies that touch on just about every entity CMS regulates,” Verma explained. “From health plans to hospitals and clinicians to post-acute care providers, we want every stakeholder focused on the need for seamless data sharing.”
Verma placed the new proposed rule in the context of the 2018 rollout of Blue Button 2.0, which provided access to claims data for nearly 40 million Medicare beneficiaries.
“Now we are requiring that other insurers follow our lead,” she said. “For the first time, we are proposing that all health plans doing business in Medicare, Medicaid and through the federal exchanges share health claims data and other important information electronically with their patients.”
If or when all those plans get up and running with interoperability and patient access as CMS envisions, 85 million patients will have access to their health claims information. That would be on top of the 40 million or so Medicare beneficiaries who already have access to their information through the Blue Button 2.0 API.
“Patients should be able to take their data as they move throughout the healthcare system, from doctor to doctor and plan to plan,” Verma said. “Just because a patient changes plans, that shouldn’t mean that they lose access to their health history. In an age when information is just a click away, patients must have easy access to their own cumulative personal health information.”
Verma said she hopes this vision is realized as soon as next year. Beyond that, she said, “we want to see a future where it’s more than notification at discharge. Instead, the entire record set will follow the patient.”
Acknowledging that, as of now, existing standards limit the flow of patient data, Verma said CMS is committed to taking a more active role in maturing and building standards. .
To that end, she announced a project that uses the FHIR Bulk Spec to share Medicare claims data with ACOs.
“And for those of you non-techies, this means we are sharing claims data for ACO participants in a bulk format. And I am pretty sure we are one of the first to do this,” Verma said.
“In putting out this proposed rule and investing in projects using FHIR standards, I’m doubling down on the need for additional standards, and I am also putting out a call to action to all of you,” Verma said. “We want the entire HIPAA designated record set made available electronically and fast. It is time to accelerate this process and give patients and providers all of the data that they need.”
Verma urged attendees to read over the entire new proposed rule—all 250 pages of it—and then offer comments.
“We review every comment, and we take each of them into consideration,” she said. “If you want to be a part of the future of healthcare IT, we invite you to work alongside us.”