New CMS guidelines promote price transparency, EHR interoperability

In addition to successfully repealing the Independent Payment Advisory Board (IPAB), which had long been an AAOS priority, Congress recently made important improvements to the Medicare Access and CHIP Reauthorization Act. At the same time, the U.S. Centers for Medicare & Medicaid Services (CMS) proposed annual updates to Medicare payment policies, including a proposed rule that makes changes to the Inpatient Prospective Payment System and the Long-Term Care Hospital Prospective Payment System. According to CMS, these policy proposals will “empower patients through better access to hospital price information, improve the use of electronic health records, and make it easier for providers to spend time with their patients.”

In particular, CMS is updating guidelines to require hospitals to publish online a list of their standard charges and to update the information at least once a year. This effort is part of a push to address price transparency, “including patients being surprised by out-of-network bills for physicians, such as anesthesiologists and radiologists, who provide services at in-network hospitals, and patients being surprised by facility fees and physician fees for emergency room visits.” According to the proposed rule, CMS is considering other potential actions that would be appropriate “to further our objective of having hospitals undertake efforts to engage in consumer-friendly communication of their charges to help patients understand what their potential financial liability might be for services they obtain at the hospital, and to enable patients to compare charges for similar services across hospitals.”

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Additionally, CMS is overhauling the Medicare and Medicaid Electronic Health Record (HER) Incentive Programs, including changing the name of the meaningful use program to “Promoting Interoperability Programs.” The rule would keep in place the program’s 90-day reporting period—that CMS shortened last year—and which requires all eligible hospitals and critical access hospitals to use the 2015 Edition of CHERT. Finally, CMS is asking for responses to a request for information (RFI) on interoperability, or the sharing of healthcare information between providers, including the possibility of revising Conditions of Participation related to interoperability to increase electronic sharing of data by hospitals.

“We are seeking information from the public regarding barriers preventing providers from informing patients of their out of pocket costs; what changes are needed to support greater transparency around patient obligations for their out of pocket costs; what can be done to better inform patients of these obligations; and what role providers should play in this initiative,” the agency stated. CMS is also considering making information regarding hospital noncompliance with the requirements public and intends to consider additional enforcement mechanisms in future rulemaking.

Over the years, AAOS has continually urged CMS to reduce the regulatory burden on providers and to improve interoperability. Additionally, while it supports the removal of burdensome and duplicative measures, the AAOS is reviewing the list of the proposed measures for removal so that orthopaedic surgeons can continue to participate in the quality reporting programs without additional barriers. Further, AAOS recently submitted a statement for the record to Congress that addressed price transparency, and it will likely reinforce that message to CMS.

“AAOS welcomes any tool that would allow physicians to make better informed decisions about what care is most suitable and cost-effective for their patients,” the letter to CMS stated. “While all payer claims databases (APCDs) are one solution, obstacles remain to effectively implement these databases, including accurate identification of providers, and ensuring that an APCD’s pricing and quality data are always timely and complete. Nevertheless, AAOS believes that APCD data can be combined with other sources of clinical data (such as that contained within registries) to expedite movement toward value-based care assessment.”

On April 27, CMS released additional proposed payment rules, including those that will update Medicare policies and rates under the Skilled Nursing Facilities Prospective Payment System, Inpatient Rehabilitation Facilities Prospective Payment System, Hospice Wage Index and Payment Rate Update, and Inpatient Psychiatric Facility Prospective Payment System.

AAOS will submit comments on the relevant proposed rules by their respective deadlines. The inpatient proposed rule and the interoperability RFI (CMS-1694-P) are available at https://bit.ly/2qVhFNK.

For more information on how AAOS requests have been addressed by Congress, see “Bipartisan Budget Deal Addresses Numerous AAOS Priorities,” AAOS Now, May 2018.

Elizabeth Fassbender, Esq., is the communications manager in the AAOS Office of Government Relations.