A final rule announced Aug. 1 by the Centers for Medicare & Medicaid Services (CMS) makes changes to hospitals participating in the Medicare Promoting Interoperability Program that should result in better data to help improve responses to public health threats. The rule, which takes effect Oct. 1, gives hospitals greater financial incentives to report patient illness, injury and treatment information electronically to state and local health departments.
In comments submitted in June, The Pew Charitable Trusts urged CMS to adopt several requirements that were eventually included in the rule. For example, hospitals that are taking steps to use their electronic health record (EHR) systems to share data with public health agencies – replacing slower and less efficient reporting methods such as phone calls and faxes – will avoid Medicare payment reductions that others may face. if they don’t connect their systems.
Public health officials rely on patient data from hospitals to help identify health threats and inequities in the communities they serve. But many agencies aren’t getting enough of this valuable information: Even before the COVID-19 pandemic, nearly three-quarters of hospitals had problems sending data to health departments. In addition, the reports sent often lacked details such as patient contact information or demographic data.
These problems persist today and, in some cases, have been compounded by the many effects of the pandemic. This means state and local authorities can miss opportunities to contain infectious diseases, respond to emerging threats, improve care for underserved residents, and ultimately save lives.
EHRs remain a key part of the solution. The first signs of an outbreak often appear in the symptoms and diagnoses recorded in these digital tools. Health departments can analyze EHR data to discover demographic groups or areas of a community that are experiencing higher rates of a particular disease or adverse health effects, which helps them target and adapt resources to residents who need them most. Importantly, 96% of hospitals already use EHRs, and these systems can be configured to automatically forward patient case reports, lab results, etc., to the appropriate state and local authorities.
For many years, hospitals could qualify for federal incentive payments by demonstrating that they were using EHRs to improve patient care. Given that Medicare is the largest purchaser of health care in the United States, such incentives produce real change. For example, after the CMS required hospitals to report test results electronically to health services, the share of these rose from 55% to 92%.
Under the updated CMS Rule, the program’s focus on interoperability and public health reporting will increase in three important ways. Hospitals will:
- Earn extra points in calculating Medicare payment rates if they take steps to use EHRs to share data electronically with health agencies.
- Demonstrate progress in moving from establishing and testing these EHR connections to sending real clinical data to public health agencies in a limited timeframe, starting in 2024.
- Report to CMS on its level of engagement with public health agencies to support the electronic exchange of patient data.
The latest requirement could give federal, state, and local authorities important insights into barriers that hinder electronic public health reporting by healthcare facilities. In 2019, a nationally representative survey of hospitals across the country found that more than half had experienced one or more reporting issues, most commonly related to understaffing or limited technical ability to send data. to agencies. Small and rural hospitals were among those most likely to encounter difficulties.
CMS may update its incentives annually to promote interoperability. As it considers future changes, the agency should take steps to encourage hospitals to make measurable improvements in the timeliness and completeness of their public health reporting. For example, new requirements could measure the quantity and quality of data sent to public health agencies, such as the proportion of records containing critical information such as phone numbers, addresses, race and ethnicity of patients.
Effective public health strategies against COVID-19, monkeypox, community-level health inequities drivers, and other critical health issues require good clinical evidence. With the widespread adoption of EHRs, hospitals can share this information with healthcare agencies quickly and efficiently. Changes to CMS incentives should help make these data connections a reality.
Lilly Kan leads The Pew Charitable Trusts Public Health Data Improvement Project.