Today, the Trump Administration proposed changes to further the agency’s priority to transform the healthcare delivery system through competition and innovation while providing patients with better value and results. The proposed rule would update Medicare payment policies for hospitals under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year 2020 and advances two key CMS priorities, “Rethinking Rural Health” and “Unleashing Innovation,” by proposing historic changes to the way Medicare pays hospitals.
“One in five Americans are living in rural areas and the hospitals that serve them are the backbone of our nation’s healthcare system,” said CMS Administrator Seema Verma. “Rural Americans face many obstacles as the result of our fragmented healthcare system, including living in communities with disproportionally higher poverty rates, more chronic conditions, and more uninsured or under insured individuals. The Trump Administration is committed to addressing inequities in healthcare, which is why we are proposing historic Medicare payment changes that will help bring stability to rural hospitals and improve patients’ access to quality healthcare.”
The inpatient hospital wage index specifies how inpatient payment rates are adjusted to account for local differences in wages that hospitals face in their respective labor markets. It is intended to measure differences in hospital wage rates across geographic regions and is updated annually based on wage data reported by hospitals. Hospitals located in areas with wages less than the national average receive a lower Medicare payment rate than hospitals located in areas with wages higher than the national average. For example, a hospital in a rural community could receive a Medicare payment of about $4,000 for treating a beneficiary admitted for pneumonia while a hospital in a high wage area (like many urban communities) could receive a Medicare payment of nearly $6,000 for the same case, due to differences in their wage index.
In last year’s proposed rule, CMS invited comments on changes to the Medicare inpatient hospital wage index. Many responses reflected a common concern that the current wage index system makes the disparities between high and low wage index hospitals worse. High wage index hospitals, by virtue of higher Medicare payments, can afford to pay their staff more, allowing the hospitals to continue operating as high wage index hospitals. Conversely, low wage index hospitals often cannot afford to pay wages that would allow them to climb to a higher wage index. Over time, this creates a downward spiral that increases the disparity in payments between high wage index hospitals and low wage index hospitals, and payment for rural hospitals and other low wage index hospitals declines.
To address these disparities, CMS is proposing to increase the wage index of low wage index hospitals. This change would ensure that people living in rural areas have access to high quality, affordable healthcare. CMS is considering several ways to implement this change, and the agency looks forward to comments on the different approaches.
The Trump Administration is also announcing proposals that would ensure Medicare beneficiaries have access to a world-class healthcare system by unleashing innovation in medical technology and removing potential barriers to innovation and competition in order to expedite access to novel medical technology.
“Transformative technologies are coming to the private market, but Medicare’s antiquated payment systems have not contemplated these technologies,” said Verma. “I am particularly concerned about cases that have been reported to the agency in which Medicare’s inadequate payment has led hospitals to curtail access to needed therapies. We must continually update our policies in response to the rapid pace of advancement in medical science.”
The cornucopia that is the annual HIMSS conference and tradeshow – healthcare technology’s biggest event – is behind us, but what’s left in the wake is wonderful, inspiring even, if not a bit overwhelming. The reactions to this year’s event have been overwhelmingly positive. Interoperability in the form of data sharing and a ban on patient health information blocking by CMS (through proposed rules released the first day of HIMSS) set the tone.
This was followed by CMS administrator Seema Verma taking a strong tone in all of her presentations at HIMSS, with the media and during her keynote speech. The federal body made it clear that data generated from patient care is, unequivocally, their data. While these themes heavily influenced the show, there were other takeaways.
There are many other diverse opinions about what came out at HIMSS19 and the themes that will affect healthcare in the year ahead. For some additional perspective, I turned to healthcare’s thought leaders; people who are a lot smarter than I. Their responses follow. That said, did we miss anything in the following?
Dr. Geeta Nayyar, Femwell Group Health and TopLine MD
After spending a week surrounded by some of the most intellectual and innovative minds globally in healthcare at HIMSS19, I’m even more confident that the shift toward patient engagement mass adoption is well underway and ON FHIR. The new CMS/ONC proposed law around interoperability and penalties for “information blocking,” are both touchdowns for the quarterback, which remains to be patient engagement. The robust discussions during the pre-conference HIMSS patient engagement program, reflected a move to a consumer-centric approach evidenced by the presence of Amazon, Google and Microsoft at the show. The keynote by Premier’s CEO Susan Devore shared a consumer-centered, provider led vision, “with data flowing seamlessly and being analyzed and effectively leveraged to guide decision making at the point of care.” Collaboration in healthcare is the key to everyone’s success. I was inspired to see her and so many women coming together to support each other in HIT, as Dr. Mom remains the healthcare decision maker in the households, we are all ultimately trying to reach.
Andrew Schall, Modernizing Medicine
Physician burnout continues to be a hot topic coming out of HIMSS19 and many feel that EHR platforms may be a part of the burnout epidemic. There were several sessions that focused on user-centered design at HIMSS this year including one that focused on the iterative approach to software development and user experience. First, I think that the industry is recognizing that one-size-fits doesn’t work for EHRs. Additionally, I believe that improvements will come in large part from the greater involvement of practicing physicians in designing specialty-specific EHR workflows and interfaces. A combination of powerful technology like AI and augmented intelligence, as well as well-designed EHR solutions with an intuitive user interface and user experience, will help ease the physician burden and automate time-consuming and administrative tasks like coding and billing – ultimately reducing burnout.
Shane Whitlatch, FairWarning
HIMSS 2019 showcased the ongoing digital transformation to make healthcare responsive to patients across a continuum of care. Enabling patients to be able to access, use and own their personal health data, while ensuring privacy and security was the central takeaway of this year’s HIMSS. Notable, critical moves to support this goal included: the Department of Health and Human Services announced proposed rules to enhance interoperability and data access with payor data; ongoing security and privacy efforts to ensure appropriate patient access to their data while mitigating emerging risks from items including medical devices to nation-state attackers; and artificial intelligence and machine learning initiatives to effectively manage the tsunami of data in healthcare while promoting optimal healthcare.
Tripp Peake, LRVHealth
The best part of HIMSS this year was we seemed to get away from a single buzzword. Healthcare is hard, there’s no silver bullet. The Precision Medicine Summit got into the weeds about how to really roll out a program in a provider system. The AI companies stopped talking about AI for AI sake and were more focused on ROI. Everyone seemed more balanced about VBC: yes, inevitable, but also gradual. Consumerism was probably as close to a central theme as existed. And I continue to be excited about the energy, creativity, and commitment of the entrepreneurs in this market.
Don Woodlock, InterSystems
Anytime you bring 43,000 healthcare professionals together in one location, you will never have a shortage of opinions on the future of the industry. We are at the cusp of a revolution in healthcare, driven by technological advancements. Some key trends we saw at HIMSS19 were, no surprise, around artificial intelligence, where people are trying to enhance predictive risk scoring and improve patient engagement. Additionally, there were profound announcements around mandating application programming interface (APIs) to improve the flow of healthcare data across the ecosystem. As interoperability becomes liquid, it will become the critical component of every healthcare system, driving the industry to new heights.
Paddy Padmanabhan, Damo Consulting
On day one of the conference, the HHS sucked the oxygen out of the room by dropping a proposed 800-page rule on data and interoperability. The rule aims to aggressively expand interoperability by making it mandatory for providers and health plans participating in government programs such as Medicare Advantage, CHIP and others to make patient data available to patients as a condition for business. CMS head Seema Verma and ONC Chief Don Rucker drove the message home repeatedly during the conference. Indeed, Seema Verma declared it an epic misunderstanding that patient data can belong to anyone other than the patient. A somewhat sobering counterpoint was voiced by Epic Systems CEO Judy Faulkner in a media interview where she suggested that interoperability challenges go well beyond data sharing by EHR vendors. Regardless of where it may fall, interoperability will continue to dominate healthcare IT agenda for some time to come. Related issues around new and emerging data sources, especially social determinants of health, will gain prominence in the coming months.
Erin Benson, LexisNexis Health Care
The proposed rule on interoperability of health information influenced most conversations at HIMSS. In the context of cybersecurity, the rule served as a reminder that it’s just as important to let “good guys” in quickly and seamlessly as it is to prevent unauthorized access. We want to enable value-based care and give patients the ability to manage their own health by having access to their records. We also want to keep costs low and efficiency high by enabling interoperability and giving partners, vendors and employees necessary access to systems. Therefore, a cybersecurity strategy needs to strike a balance between user engagement and data security.
Mike Morgan, Updox
The power of consumerism is really impacting healthcare and the need for patient engagement is alive and well. Providers across the board must look at new technologies and ways to redefine patient engagement to better communicate with patients and partners but do it via channels that are easy for staff and customers to use. New applications, such as telehealth and secure text messaging, have changed how healthcare communicates and consumers are demanding that immediate, convenient engagement.
Vince Vickers, KPMG
HIMSS19 seemed to have the most decision makers at the conference in five-plus years when a lot of healthcare organizations were still looking at implementing electronic health records. We might be ready for another wave of healthcare IT investment after healthcare organizations digested those investments made in electronic health records. The key is now around optimizing EHRs – interoperability, improving ease of use, enhancing analytics — or dedicating resources to enterprise resource planning (ERP) systems to make themselves more efficient in the back office. We’re also seeing healthcare organizations position themselves to be more consumer-oriented, partly to address new entries from some of the tech companies, such as Google, Amazon, Microsoft, and a multitude of others, that wanted to make a big splash at HIMSS.
The megalithic healthcare conference, HIMSS19, has come and has gone from the vast former swampland of central Florida. While I’m a relative newcomer to the show’s trajectory – I’ve been to four of the annual tradeshows since 2011 – this year’s version was, for me, the most rewarding and complete of them all. This could be for one of several reasons. Perhaps because I no longer represent a vendor so sitting in the exhibit hall in a 30×30 booth with a fake smile wondering when the day’s tedium would end and the night’s socials would begin may impact my rosy outlook.
Or, maybe I was simply content to engage in the totality of the experience, attend some quality sessions, meet with many high-class people and discuss so-called news of the day/week/year. Doing so felt, well, almost like coming home. Or, perhaps my experience at the conference this year was so good because of running into former colleagues and acquaintances that drove me to such a place of contentment while there. No matter the reason, I enjoyed every minute of my time at the event.
Something else felt right. An energy – a vibe – something good, even great, seems/ed about to happen. Something important taking place in Orlando, and I was blessed to be a part of it. Kicking off the week, CMS created news – like it does every year at about this time – with its announcement that it will no longer allow health systems and providers to block patients from their data. This was a shot across the bow of interoperability and the industry’s lack of effort despite its constant gibberish and lip service to the topic.
Another fascinating thing that finally occurred to me: no matter the current buzzword, every vendor has a solution that’s perfect for said buzzword. Be it “patient engagement,” “interoperability,” “artificial intelligence,” “blockchain”; whatever the main talking point, every organization on the exhibit floor has an answer.
But, no one seems to have any real answers.
For example, after nearly a decade, we still don’t have an industry standard for interoperability. Patient engagement was once about getting people to use patient portals for, well, whatever. Then it was apps and device-driven technologies. We’re now somewhere in between all of these things.
AI? Well, hell. It’s either about mankind engineering the damnedest algorithms to automate the hell out of everything in the care setting (an over exaggeration) or that AI/machine learning will lead to the rise of machines, which will help care for and cure people – before ultimately turning on us and killing or enslaving us all (again, I’m overly exaggerating).
During her trip to HIMSS19, Center for Medicare & Medicaid Service administrator Seema Verma spoke with registered members of the media to preview her keynote speech and answer questions about her department’s newly released proposed interoperability rule. The rule dictates that data generated by patients while in the scare setting is theirs to own, transfer and share with caregivers. It also would require healthcare providers and plans to implement open data sharing technologies to support transitions of care as patients move between these plan types.
In a statement released prior to her meeting with the media, Verma said that ensuring patients have easy access to their information, and allowing that information to follow them on their healthcare journey “can reduce burden, and eliminate redundant procedures and testing, thus giving clinicians the time to focus on improving care coordination and, ultimately, health outcomes.”
During her meeting with the media at HIMSS, Verma started by discussing CMS’ “why” — why CMS is moving toward enhanced patient empowerment – as well as her and the administration’s focus on the improving the sustainability of the healthcare community.
Patient empowerment remains front and center for the agency, she said. For example, from the patient perspective, everyone has their own experience of going to the healthcare system and not being an empowered patient, she said, and not having access to data decreases patient engagement. CMS is working to change that, now.
When people understand their health and participate in their health, this has the ability to improve care outcomes, she added, and through complete access to their healthcare records, patient care can be more complete. Ultimately, she said, with every detail of a person’s health information in one place — and accessible to the patient — will kick start the digital health data revolution.
Matthew Fisher, attorney at Mirick O’Connell, a Massachusetts-based law firm, spoke to Electronic Health Reporter during HIMSS19, following the release of a new proposed rule by HHS. The proposed rule outlines potential sanctions and penalties placed upon healthcare organizations and physicians that keep information from patients, known as information blocking.
In her explanation of the rule, Administrator Seema Verma took a strong tone in supporting patient access to their health information and ownership of patient data. “One thing that I want to make very clear for the entire healthcare system is that the data belongs to the patient. It’s their data. It doesn’t belong to the provider. It doesn’t belong to the EHR company. It belongs the patient.”
Based on these sentiments and the proposed rule, here Fisher speaks about what it ultimately may define, and its potential impact on providers and healthcare organizations. Listen to our full conversation here:
Following the release of its proposed new rules designed to improve the interoperability of electronic health information, members of leadership from the Centers for Medicare & Medicaid Services (CMS) hosted a call to provide additional detail about the proposed rule, and to answer questions from the media. The following includes the key takeaways from the officials hosting the call.
Seema Verma, Administrator, CMS
CMS shares a commitment with patients to obtain and share their health data.
The proposed rules ensure patients have access to their records in digital format.
We are “unleashing” data for research and innovation while tackling what might be the greatest healthcare challenge in our history, including the potential upcoming healthcare cost crisis that could destroy the US economy.
MyHealthEData unleashes innovation and focuses on results.
CMS is doubling down by requiring health plans to release claims data. All health plans in Medicare, Medicaid and that have plans within the federal exchange must allow for information be shared so patients can take their records with them when they move on.
Through these efforts, more than 125 million patients will have access to health information and be able to take information with them.
We are putting an end to information blocking and will publically identify doctors, hospitals and others who engage in information blocking.
Patient data doesn’t belong to doctor, but to the patient.
We’re putting the patient at the center of healthcare data. The time of keeping patients in the dark to trap them in systems so that they can never leave are over.
We are empowering patients to understand their healthcare information.
This rule allows patients to aggregate their data in one place through APIs/apps – putting the data in one place to help them understand it. They can organize the information, create care reminders, take data for the next provider when they go to a new provider.
This allows for aggregation of data in one place; physicians no long need to duplicate tests, for example.
Patients can donate their data for research, if they so desire, possibly opening up new wave of innovation of development.
Don Rucker, MD, National Coordinator for Health Information Technology (ONC)
Thank you Jared (Kushner) for that kind introduction. It has been an honor to work alongside visionaries like you; somebody who really understands at a very personal level as I do, the need and potential of innovation to better serve Americans. Having the Office of American Innovation involved is critical, and I’m grateful for Jared’s involvement, his hard work, and his leadership. It’s an honor to serve with him, and I am grateful for his service to our country.
We have procedures that we couldn’t have imagined a generation ago that are saving thousands of lives.
Precision medicine has opened the door to a new world of therapies specifically tailored to a patient’s unique genetic code.
We can now treat retinal disease that causes blindness.
Robotic technology is making surgeries less invasive, and we are on the verge of having the world’s first artificial pancreas.
3D training tools are enabling doctors to learn anatomy without a cadaver.
Telemedicine is also improving access to care and empowering CMS beneficiaries to lead healthier lives.
And it doesn’t stop with traditional healthcare innovators. The automobile industry is partnering with leading technology companies to perfect driver-less cars that may one day give independence to our nation’s elderly and people with disabilities. And through smart phones and wear-able technology, we are compiling health information every second, and Americans are using that information to track activity, calories, and heart rates. Innovators are even developing ways to monitor chronic illness with electronic watches. The list of innovation is endless.
But while all of this technology is changing every area of our lives, we face enormous challenges in healthcare, and the value that we are receiving for the amount of money that is being spent.
Last year CMS released a report showing that the rate of growth in healthcare spending is not slowing down. Despite all of the changes and regulations over the past decade, healthcare continues to grow more quickly than the overall economy. By 2026, we will be spending one in every $5 on healthcare.
This matters to each and every one of us because this increase in spending will continue to crowd out funding for other priorities, such as roads and schools, as well as national defense. Not to mention it means higher healthcare spending for each and every one of us. We’ve already seen our costs go up, with health insurance premiums, co-pays and deductibles.
And yet, this national increase in spending has not addressed many of America’s healthcare challenges. Entire communities have been ravaged by the opioid epidemic, and we rank poorly compared to other countries when it comes to preventing premature births, infant mortality and chronic diseases. It’s clear that when it comes to the most consequential measures of health and wellness, we need to get much more for our money.
The system we have is unsustainable, and it cannot continue. And President Trump agrees.
Last year, the President announced an Executive Order: Promoting Healthcare Choice and Competition Across the United States. Through his executive order the President made clear that he wants his administration working to change the rate of growth of healthcare spending so that competition can be fostered in healthcare markets, so that patients, and the American people, may receive better value for our investment in healthcare.
Secretary Azar and I are working for competition and better value by moving away from a fee-for-service approach, to a system that is value-based – and that rewards value over volume. This means paying providers on the outcomes they achieve, making people healthier rather than how many procedures they perform. Now many of you have heard this all before.
But, I’ve always been struck by how seldom the patient is mentioned in discussions around value-based care. Let me be clear, we will not achieve value-based care until we put the patient at the center of our healthcare system. Until patients can make their own decisions based on quality and value health care costs will continue to grow at an unsustainable rate. This administration is dedicated to putting patients first, to be empowered consumers of health care that have the information they need to be engaged and active decision-makers in their care. Through this empowerment, there will be a competitive advantage for providers that deliver coordinated, quality care, at the best value, to attract patients who are shopping for value.
I have spent a lot of time talking to Americans from all walks of life, and they are demanding more accountability from the health care system. As they are paying more through higher premiums and higher deductibles, they want to know how much services are going to cost, and they want to shop around for the best price. They don’t want to be paying for duplicate tests, or unnecessary care, and they are demanding a higher level of service and efficiency from the healthcare system.
In every other area of our lives, we are receiving better services that leverage innovation in technology. We can take our ATM card to any bank across the globe, and that bank can access our accounts. We can track every credit card purchase, and every phone carrier honors our cell phone number, and we receive ads for products we were only thinking about buying – or so it may seem.
So it should be no surprise that Americans have the same consumer friendly demands for healthcare. Americans are demanding that when they go to the doctor, the doctor spends more time with them, and less time on paperwork or typing into a computer.
To that end, in our drive towards value-based care, CMS adopted an approach that we call “Patients Over Paperwork.” Patients Over Paperwork is a direct result of President Trump’s Cut the Red Tape initiative, which aims to restore patients as the priority of everything we do, and eliminate burdensome regulations that have outlived their purpose.
We have held meetings in cities across America, and received thousands of letters. And one of the most common complaints we have heard from both patients and providers has been the inefficiency of Electronic Health Records – or EHRs, and the inability of providers to effectively coordinate care for their patients.
Now tremendous progress has been made in the adoption of EHRs. The technology for data sharing has advanced, and data is often shared effectively within a given healthcare system, with inpatient and outpatient doctors in the same provider system able to share and edit the same clinical record.
Despite this progress, it is extremely rare for different provider systems to be able to share data. In most cases there is not yet a business case for doing that – it’s in the financial interest of the provider systems to hold on to the data for their patients.