CMS Interoperability Rule requires hospital action within 6 months

Authored by Bret Ammons

On March 9, 2020, the Department of Health and Human Services issued two new rules regarding the interoperability and patient access provisions of the 21st Century Cures Act immediately impacting hospital systems.

We will continue to monitor developments regarding the new Interoperability Rule for changes, including deferrals or delays in implementation deadlines due to the current challenges hospitals face.

Key actions required within 6 months of publish in the Federal Register:

• Hospitals must be able to make electronic notification of a patient’s Admission, Discharge, and Transfer (ADT) events available to other hospitals, healthcare facilities, community providers or practitioners.
• Hospitals must publish their digital contact information such as secure digital endpoints like a Direct Address and/or a FHIR API endpoint in the National Plan and Provider Enumeration System (NPPES).

Rules generally take 1-3 months to be published in the Federal Register. Once published, hospitals will have 6 months to implement changes and become compliant.

Impact to hospital systems

Hospital organizations that are now prioritizing and ramping up to meet the needs of the burgeoning COVID-19 virus pandemic were introduced to a new deadline from CMS. To meet this deadline, hospital systems also need to mobilize now to define and execute on a strategy for health data sharing based on the new Fast Healthcare Interoperability Resources (FHIR) standard adopted by CMS. 

The current rule requires hospitals to share ADT information and publish their data endpoint; however, this is only the first step in data sharing rules that CMS will adopt in the future – a robust strategy and data architecture should be developed as part of this effort to support long-term, future data sharing requirements.

Potential Penalties: The Cures Act that authorizes the CMS rule also provides for potential penalties of up to $1 million dollars for organizations found to commit information blocking (not sharing patient event notifications); however, the actual rules for the penalty have not yet been written.  The sharing requirement is also considered a Condition of Participation (CoP) in the Medicare program, and a violation can be considered non-compliance.

How Baker Tilly can help

Your data infrastructure will be an increasingly important foundational capability as these guidelines and more complex contracting come to fruition. Baker Tilly’s experienced healthcare and digital transformation consultants can work with your organization to enhance your systems:

• Analyze current data sharing infrastructure. Determine the capability and barriers of your current EHR system to share data effectively.
• Recommend digital data sharing strategy. Define the organization’s data sharing strategy. Develop a digital transformation roadmap that supports immediate deadlines and builds a foundation for future capability.
• Implement digital transformation. Rapidly stand-up a project team to implement the transformation, including the technology and process implementations.
• Manage the change. Build and execute a change management plan to ensure adoption of any workflow changes and to communicate relevant data sharing strategy messaging to key stakeholders.

Connect with us to discuss how your organization can best approach compliance with the new interoperability rule provisions.