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Boosts to Interoperability Implementation May Give Skilled Nursing a Leg-Up in Meeting CMS Requirements


Interoperability can be a point of frustration for health care professionals considering the difficulties it can impose. If you’re not familiar with it, the term refers to the ability of various health care providers to collect and share patient information electronically through an electronic health record (EHR), also known as an electronic medical record (EMR). EMR also can refer to internal electronic records that are used for diagnostic purposes but not intended for distribution outside the private practice.

Though EHR and EMR are technically different, the terms are often used interchangeably to refer to the former definition. The fact that the industry has not cemented definitions for terms critical to understanding and implementing interoperability demonstrates the many hurdles providers have faced and will continue to face. The process to meet interoperability standards established by CMS and demanded by health care consumers is still fresh for hospitals, health systems, and private practice physicians; indeed, some providers have yet to complete the transition to EHR altogether. And now the interoperability wave is headed for skilled nursing.           

Legislation Moves Forward

In June, the Senate passed S. 1916, the Rural Health Care Connectivity Act of 2015, which may serve as a small victory for rural skilled nursing providers tangled in the interoperability implementation web. The bill will go to the president, who is expected to sign it into law. The bill has significant implications for rural skilled nursing providers, because it allows these facilities to apply for funds to support broadband connectivity and telecommunications technology (telehealth). When the FCC created the Healthcare Connect Fund in 2012, skilled nursing properties were excluded from the pilot, which was designed to provide rural health care providers the financial support needed to boost broadband in hard-to-reach areas. The Rural Health Care Connectivity Act will grant the FCC statutory authority to extend the pilot to skilled nursing providers.

One reason why this act is so important for skilled nursing is because of requirements for interoperability, as outlined in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). The IMPACT Act mandates that skilled nursing properties submitting claims to Medicare for reimbursement must meet certain interoperability measures, which means that the EHRs compiled and maintained for residents by the facility must be kept in a format that can easily be shared among all types of health care providers. While other types of providers received funding assistance from Congress to implement EHR programs, skilled nursing providers did not receive additional funds in the IMPACT Act. The Rural Health Care Connectivity Act will be a welcome support for rural skilled nursing operators that are struggling to implement these interoperability regulations. In an article by McKnight’s, Dan Holdhusen, Evangelical Lutheran Good Samaritan Society’s director of government relations, said, “Passage of this bill marks the end of an arduous effort on behalf of skilled nursing facilities to gain access to [Rural Health Care Program] funds.”  Interoperability is one of the many intimidating requirements of the IMPACT Act, which may eventually translate into Medicaid requirements, as well.

Measuring Interoperability

The way CMS measures interoperability is also hotly contested at the moment in light of a Request for Information (RFI) submitted by the Office of the National Coordinator for Health Information Technology (ONC) in April. The implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) gives ONC the opportunity to adjust how interoperability is measured. Interoperability today is measured against “Meaningful Use” requirements, which use data exchange frequency to determine if providers are meeting interoperability standards. In response to the RFI, provider groups such as the American Hospital Association and the American Medical Association stated in strongly worded comments that Meaningful Use is not an appropriate measure of interoperability. The groups contend that interoperability should not create a burden for physicians and that standards should be based on a patient-centered approach that promotes care coordination, rather than on the frequency and volume of data exchange providers incur.

If new interoperability standards are adopted by ONC, many providers will be happy, but many will also need cash inflow to meet those standards. Skilled nursing providers, having been left out in previous electronic health records supports, will be chief among those asking for additional funds to ramp up their IT capabilities.

On the one hand, the RFI submitted by ONC indicates that CMS is following through with its commitment to working with providers to implement the myriad changes to health care regulations facing the industry. On the other hand, because interoperability is still fresh to the industry and the policy makers behind the regulations and legislation governing its formation, the act of implementation is a moving target. As NIC aptly pointed out in the theme of its 2016 Spring Investment Forum, the challenge for skilled nursing providers now is timing the wave. If skilled nursing providers either already have or are currently quickly adopting interoperability technology that complies with today’s standards, they might be forced to revamp again when the standards change based on the ONC RFI. If they wait too long to integrate interoperability technology into their services, they risk being left behind or being considered noncompliant with CMS standards.

Skilled nursing and the third-party companies that provide their EHR platforms will aim to find the sweet spot. Rural skilled nursing providers may get a boost through the Rural Health Care Connectivity Act of 2015, while urban and suburban providers may have to fend for themselves to gather the finances needed to build strong interoperability platforms.

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