This week, ASCRS submitted comments on two proposed rules dealing with the interoperability of health information. In our comments on the two proposed rules—one for CMS and the other for the Office of the National Coordinator for Health IT (ONC) that each cover programs under their individual jurisdictions—we applaud the administration’s efforts to improve the flow of electronic health information and give patients access to their health data. Despite this, we caution the administration about placing too much emphasis on the ability of patients to make more cost-effective decisions about their healthcare with this information.
While the administration envisions patients becoming savvier consumers of healthcare, ASCRS notes in our response to the CMS proposed rule, which covers Medicare Advantage (MA), Medicaid and federal exchange plans, that ophthalmologists tend to treat a more elderly cohort of beneficiaries who may not want, or have the ability, to access their electronic health information. Furthermore, we note that most small ophthalmic practices are not able to negotiate rates with MA plans and may not be permitted to participate in some plans seeking to narrow their networks, which means that most beneficiaries will not have many options for choosing their physicians. Finally, we recommend that CMS also require MA plans provide their beneficiaries with additional information on quality and outcomes, rather than encourage them to seek care just based on price, and to provide additional information to the patient on step therapy and prior authorization used by the plan, which may limit access and impact the quality of care.
In response to the ONC proposed rule, which covers health IT systems such as EHR, ASCRS supports ONC’s proposal to require that EHR systems provide a function to download a patient’s complete medical record, or all the records in a practice, to facilitate the interoperability of electronic health information and make it easier for physician practices to migrate data if they switch EHR systems. While we are encouraged that ONC takes steps in the proposed rule to prevent EHR vendors from blocking the flow of data, we continue to caution that vendors will look for ways to circumvent the requirements to keep or grow their market share. Specifically, we support the proposal to require EHR vendors to make data available through open applications programming interfaces (APIs) but note that this is currently required as part of the Promoting Interoperability category of MIPS, and practices report that vendors routinely take steps, such as charging additional fees or not allowing bi-directional flow of information, that can make it difficult for physicians to use the tools effectively.
CMS and ONC propose for the provisions in the rules to begin taking effect in 2020, but it is unclear when a final rule will be released. We will keep you updated.