More than 60 percent of Stage 3 Meaningful Use measures require interoperability, up from 33 percent in Stage 2. However, the shift from fee-for-service to value-based payment models—more than any other factor—could be the main driver for stimulating demand for interoperability among providers.
The Centers for Medicare and Medicaid Services touts Stage 3 objectives and measures as “advanced use of health information exchange functionality” that providers will be required to comply with in 2018. But, Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, argues that what is actually more important than Stage 3 in terms of driving interoperability is the Department of Health and Human Services’ delivery system reform initiative.
“By driving accountable care, CMS is also driving greater demand for interoperability,” says Tripathi. “What is important about Stage 3 is that CMS hopes to motivate the laying down of the infrastructure to do the things that accountable care is providing incentives for.”
In January 2015, HHS announced a rapid timeline for shifting Medicare reimbursements from volume to value. The agency has set a goal of tying 30 percent of traditional fee-for-service Medicare payments to quality or value through alternative payment models—such as accountable care organizations or bundled payment arrangements—by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.
At a press conference announcing the final Stage 3 rules on October 6, Patrick Conway, M.D., CMS chief medical officer, asserted that by 2018 these rules will move the industry “beyond the staged approach of Meaningful Use and focus on broader delivery system reform” based on the quality—rather than quantity—of care delivered.
“The lack of interoperability is a demand problem. It’s a function of not enough demand from providers and we’re now finally starting to see that change,” observes Tripathi. “Providers are absolutely demanding it. I’ve been involved in vendor selections over the last six months where providers are using interoperability as one of the key evaluation criteria for choosing vendors—that is a much bigger motivator for interoperability than Meaningful Use.”
It’s a lesson that has not been lost on the Office of the National Coordinator for Health Information Technology. Earlier this month, ONC released the final version of its Nationwide Interoperability Roadmap, which emphasizes that rules governing how healthcare is paid for must create a context in which interoperable health IT is not just a way to improve care but is a good business decision.
“Shifting payment models to those that pay for quality versus quantity is pivotal to creating the business imperative for interoperability,” states ONC’s Roadmap. “While the Medicare and Medicaid EHR Incentive Programs have been a primary motivator for the adoption and use of certified EHR technology among specific groups of clinicians, these programs alone are insufficient to overcome barriers to the Roadmap’s vision for information sharing and interoperability. The current business environment does not adequately reward, and often inhibits exchange of electronic health information, even when it is technically feasible. History has shown that without the right financial incentives in place, systems and technology components are built and not used.”
As CMS released the final Stage 3 rule, ONC issued its 2015 Edition final rule establishing HIT certification criteria that support interoperability. The rule seeks to improve interoperability by adopting new and updated vocabulary and content standards for the structured recording and exchange of health information, including a Common Clinical Data Set.
“What has evolved with the release of Stage 3 is a very clean separation between ONC’s role—to specify what is certified EHR technology—and CMS’ role, which is to define the incentives for the Meaningful Use program,” comments David McCallie, M.D., senior vice president of medical informatics for Cerner.
Standards are necessary, but are not sufficient, for interoperability to occur, concludes McCallie, who has served on ONC’s HIT Standards Committee. “A group of healthcare entities must choose to deploy and use the standard, in service of some business purpose, which may include satisfying regulatory requirements or meeting market pressures, or both.”
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