Editor’s Note: On July 23, 2015 Paul Black testified before the Senate Committee on Health Education Labor and Pensions, to share his thoughts about how to advance health data exchange. This post is the second in a three-part series that will address aspects of interoperability: 1) overcoming barriers 2) financial motivation and standards, and 3) information blocking.
The current payment system simply does not offer appropriate financial motivation for providers to create an interoperable healthcare environment; this is especially true given that the burden of cost falls to them almost exclusively. Healthcare providers are genuinely committed to providing the best care they can to patients, but the common reality of running on only a few days’ cash flow sometimes trumps loftier goals.
Much as CMS policy has already had a marked impact on hospital readmission rates by associating them with payments, creating a direct relationship between payment and data exchange would have the same result. This could be the strongest step taken to create a genuine imperative for interoperability.
H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a good start in the right direction. But Congress needs to ensure that alternative payment models envisioned in this reform are rolled out appropriately.
The good news is that the expansion of delivery reforms is already motivating accelerated electronic data exchange progress. We see this in Accountable Care Organizations (ACOs), and demonstrations like the Comprehensive Primary Care Initiative, which Allscripts supports as the technology provider for a sizable percentage of the participants.
Simply put, they create a use case for health IT that focuses on clinical value and less on what level of visit they can code. We have already seen real change result within our client base from new approaches at CMS and within the commercial payer space, and I expect that will accelerate as MACRA is implemented.
Given the volume of new programs along with Meaningful Use Stage 3, which we expect to advance interoperability, we encourage Congress to allow the impacts of these recent changes to play out further before passing additional legislation specific to interoperability. There is an opportunity to see what adjustments providers make in response to the new payment models and what steps they start taking to maximize the new revenue opportunities.
Generally, the same recommendation applies to standards development work – it is important that there be time for maturation and the fine-tuning of elements that are already being embraced by the industry (for example, Direct and CDA). There is no need to toss aside approaches that are working.
Of course we should continue to explore new and innovative approaches in an appropriately transparent manner, but standards development should have a lifespan longer than two or five years, so it’s important to move thoughtfully.
Looking to standards as a panacea for the challenges still ahead of us will only result in usability complaints from providers as immature technologies are mandated by the government. Congressional attention would be best served in directing ONC to drive greater standards adoption and consistency of implementation of those standards, rather than focusing on the need for all new standards.
In response to recent regulatory activity, as well as client requests, the private sector has been making innovative advances. There are exciting technologies and services in development now and on the product roadmaps for the next several years based on what our clients have requested. I think everyone wants to avoid a prescriptive, heavy-handed statutory or regulatory mandate in which the government becomes the de facto product manager for our industry as a whole.
Read Paul Black’s next post – Achieving the promise of health IT: Stop information blocking and data bullying