News Feature | August 22, 2013

Increased HIE Interoperability Strategies Could Affect Provider Reimbursement

Source: Health IT Outcomes
Greg Bengel

By Greg Bengel, contributing writer

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In the wake of a recent report from CMS and ONC on strategies for accelerating HIE interoperability, some wonder whether incentives and rewards will morph into mandates

In a recent Request for Information, CMS and ONC asked for input “on a series of potential policy and programmatic changes to accelerate electronic health information exchange across providers, as well as new ideas that would be both effective and feasible to implement.” Following up on the responses to that request, CMS and ONC recently released a report titled “Principles and Strategy for Accelerating Health Information Exchange (HIE).” The report outlines a strategy which they hope will accelerate interoperability of HIEs and encourage more widespread use.

An August 7 webinar also announces the strategy and the report. In the webinar, National Coordinator for Health IT Farzad Mostashari emphasizes that progress is being made. “It took a decade for ATMS to be interoperable, and they only use seven data fields,” he says.

This article in FierceEMR covers the main points of the report, laying them out as follows:

  • The use of payment models such as accountable care organizations to drive HIE
  • Advancing HIE across providers, including those not currently in the Meaningful Use Program, such as long term and behavioral health providers
  • Incorporating HIE requirements into Medicaid
  • Introducing reimbursement changes, such as a proposed complex care management fee conditioned on an electronic summary of car record exchange, which is in the proposed physician fee schedule

According to FierceEMR, there was no suggestion from the report that new rules would mandate national standards for interoperability. “ONC has already stated that it will not issue regulations regarding HIE governance, opting instead to provide voluntary guidance,” the article reads.

However, another recent article on the report, this one from Information Week Healthcare, suggests that the government may soon be basing Medicare reimbursement upon information sharing through HIEs.

The article quotes from the report that “HHS [Department of Health and Human Services] will implement policies that could encourage HIE incrementally and could evolve from incentive and reward structures to ultimately considering HIE a standard business practice for providers. It also says that "CMS is evaluating strategies that begin with incentives or rewards through value-based payment programs and end with defining well-established types of HIE as part of quality standards related to reimbursement under Medicare and Medicaid.” According to the article, CMS and ONC are talking about tying provider reimbursement directly to interoperability.