HIE, interoperability still center stage
August 8, 2013 in Medical Technology
As Farzad Mostashari, MD, prepares to leave the ONC, his office and the Centers for Medicare Medicaid Services are looking to the future and plotting long-term information exchange and interoperability policy strategies. Between meaningful use Stage 2, which is heavy on health information exchange, and the Affordable Care Act’s delivery and payment reforms in Medicare and Medicaid, the “overarching policy intent” is enabling care coordination and collaboration.
“We cannot have it be profitable to hoard patient information,” Mostashari said during a CMS and ONC webinar, emphasizing an idea he has long nurtured.
Offering a long-range vision and noting healthcare’s complexity — compared to, say, standardizing ATMs — Mostashari explained that federal health IT policies and programs are foundational tools, but not single solutions in their own right to the problems facing American healthcare.
Meaningful use incentive payments and EHR certifications “are not enough to achieve the widespread interoperability and HIE necessary for delivery and payment reform,” Mostashari said.
[See also: Interoperability in its ‘last mile’?]
And the context in which EMRs or HIEs are being used by providers is paramoount, he added. “How tools are used is critical to how care is paid for and the incentives for healthcare providers.”
Indeed, the incentives created by fee-for-service reimbursement in Medicare and private insurance have been well-known contributors to the problematic volume-based provider business model, and Mostashari himself cheers the advent of quality-based payment models and the decline (if slow coming) of fee-for-service, occasionally using the Twitter hashtag #FFSdemise.
Now that the industry is moving in that direction, Mostashari said it’s still important to have stakeholder input, from providers, payers and patients — and they are weighing in. CMS and ONC received a lot of responses to a recent request for information on advancing interoperability and HIE.
Among those suggestions: requiring digital HIE in all advanced payment models and Medicaid waivers; including long-term care, post-acute care and behavioral health providers in CMS’s state innovation model grants; extending Meaningful Use incentives to long-term, post-acute and behavioral health providers; creating reimbursement codes for care coordination enabled by tele-health and digital consults, radiology queries and evaluation and management; and extending legal exemptions for hospital EMR donations to physicians under the Stark Law and Anti-Kickback Statute.
While several of those and other ideas are being explored, Mostashari wanted to mention three projects the ONC is working on in the short-term.
[See also: Practices embracing HIE, replacing EHR.]