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What We’re Watching: January 7, 2020

TAKING CARE OF MOMS

Premier released a second data set on maternal health costs and complications.

What we’re saying: The report, which is part of the “Bundle of Joy: Maternal & Infant Health Trends Series,” is titled “The Added Cost of Complications During and After Delivery.” Premier’s analysis found that U.S. hospitals could save more than 20 percent in costs for complicated childbirths. The increased costs associated with childbirth are – in part – due to potentially preventable complications and pre-existing chronic conditions. The nationally representative study examined the cost to hospitals of providing labor and delivery care for women from 2008-2018, and specifically how the cost to hospitals varied by complication for 2.7 million maternal patients from 2015-2018.

THE REVOLUTION MIGHT BE TELEVISED

2020 represents an important start of what we expect to be a digital health revolution.

What we’re saying: We anticipate the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS) will issue their regulations on HIT interoperability, patient access and information blocking. Based on the proposed rules, we expect them early in the year and focused on:

  • Data and interoperability standards to enable data exchange
  • EHRs enabled with apps via open application programming interfaces (API)
  • Greater transparency for EHR vendors around business practices and products to help address the economic incentives that impede health IT market competition
  • Adoption of health data standards and related implementation guides as part of the EHR certification program (CEHRT)
  • Clarifications about exceptions to “information blocking”
  • Requirements to provide electronic notifications when patients are admitted, discharged or transferred (ADT)

We anticipate that these changes will improve interoperability of healthcare data, reduce the power of the EHR vendors over the use of data, increase requirements on providers to make data available to consumers and expand the use of healthcare apps.

PSA: IT’S PAMA TIME!

We’ve been telling you for a while now, but January 1, 2020, marked the beginning of the preparation period for compliance with the Protecting Access to Medicare Act (PAMA). PAMA, which aims to address waste and ensure high quality care for patients, requires the use of clinical decision support (CDS) technology for the ordering of advanced diagnostic imaging services.

What we’re saying: On January 1, 2021, CMS will begin withholding payment if proof of a qualified CDS solution is not in place when ordering advanced diagnostic imaging services. CDS tools, like the one Premier offers by Stanson Health, read available information from the electronic health record and determine a set of clinical details for the order being evaluated.

CURES REBOOT

Representatives Fred Upton (R-MI) and Diana DeGette (D-CO) issued a call to action, asking stakeholders for ideas on developing the next generation of the 21st Century Cures Act. With Cures 2.0, the lawmakers are examining the use of real-world evidence, digital platforms as sources of medical services, Medicare coverage reform, coding and payment, and family and caregiver health literacy.

What we’re saying: Premier shares Congress’ continued enthusiasm for advancing medical research and fostering innovations to develop cures and we’re never shy about sharing our ideas! As always, we base our policy recommendations on insights from data and proven strategies from Premier’s member health systems and performance improvement collaboratives. We’re asking Cures 2.0 to incorporate a number of initiatives.

NEW CANCER CARE MODEL

Premier submitted comments last week on an informal request for information from CMS on the Oncology Care First model, which would serve as the successor model to the current Oncology Care Model starting January 1, 2021.

What we’re saying: Premier largely supports the current framework that now incorporates many changes we helped advance, including risk adjustment by cancer type and the elimination of billing requirements for practice enhancement payments.

WE WANT UPIs

Lack of effective patient matching undermines care coordination and safety, and costs the average healthcare facility $1.2 million per year in lost revenue. A recent GAO report also documents provider challenges in accurately matching patient records.

What we’re saying: Premier joined 47 organization in urging CMS to share its views with Congress on the impact of lifting the 21-year ban on providing federal funding to adopt a national unique patient identifier (UPI). The legislative language preventing patient matching was enacted before the implementation of HIPAA’s robust patient privacy protections and the broad prevalence of EHRs.

IN CASE YOU MISSED IT


What We’re Watching is a bi-weekly blog focused on the current events Premier is following and their relevance to the work of Premier and its members. Check out our last update!

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