Studies have shown over and over that there are disparities in healthcare access and outcomes based on social determinants of health (SDOH) such as income and education level, environment, discrimination, and other factors. In recent years, we have seen attention turn to collecting information from patients regarding these factors and using them to help guide a patient’s care. In specialty settings, this is often seen as less important, and these factors are either not collected or dismissed as unimportant to patient care. This may all change in the near future, however, as CMS turns even more attention to the collection and use of these factors in patient care.
On July 19, 2021, the Centers for Medicare & Medicaid Services (CMS) released the 2022 proposed rule for the Outpatient Prospective Payment System (OPPS). These changes are meant to increase reimbursement rates for OPPS, implement increased penalties for price transparency violations and reverse changes to the inpatient-only list (among other things).
HIPAA violations caused by access issues have made news in recent weeks, where current or past employees have abused their access to EHR patient records to snoop on or steal protected health information (PHI). One rather disturbing example of such abuse was uncovered just this week at the Canton, Ohio-based Aultman Health Foundation. In this case, the PHI of roughly 7,300 patients was compromised (including Social Security numbers, health insurance info, home addresses, birthdates and treatment details).
The Centers for Medicare & Medicaid Services (CMS) recently released a wealth of new guidance and resources for MIPS Promoting Interoperability (PI) measures and program requirements for the 2021 reporting period. These changes are based on the IPPS (or inpatient) rule. However, the guidance released in the IPPS rule is usually mirrored in the outpatient rule, which should be released later this summer. As usual, there is a lot to go through. However, most requirements are being carried over from 2020 so only a handful of changes need to be noted by our readers (have no fear; we’ve already done the grunt work, so you don’t have to).
While the HIPAA Right of Access rule was first passed into law as part of the 2013 HIPAA Omnibus Rule, the Office for Civil Rights (OCR) has been cracking down hard on violators of this rule in recent years. This provision requires covered entities to provide patients with a copy of their medical records in the form and format requested, or another agreed upon form, within 30 days of the initial request. If the covered entity is unable to fulfill the request in that timeframe, they may notify the patient in writing that they will need a 30-day extension. This notification must also notify the requestor of the date on which the records will be provided and only one extension is permitted.
We are entering a new era of healthcare, one where the patient is empowered to direct his or her own treatment. Patients are more informed and involved in their care than ever before and app developers are tapping into people’s desire to be involved in the decision making when it comes to their care. They also expect to be readily provided with their healthcare information upon request, and legislation has been passed that will require such requests be fulfilled in a timely manner.
The submission window for MIPS Performance Year (PY) 2020 closes on March 31, 2021. As one year closes another begins, and now is the time that practices should be preparing for their 2021 MIPS reporting. For the new year, the MIPS annual program requires submission of data in four categories—Quality, Promoting Interoperability (PI), Improvement Activities (IA) and Cost. In this blog, we will briefly go over actions to be taken throughout the year for submission in PY 2021 so that our readers can be better prepared for the next MIPS reporting period.
On December 10th, 2020, the Office for Civil Rights released a proposed rule to modify the current HIPAA Privacy Rule. While this rule is not yet finalized, it is important that practices are aware of the proposed changes and begin to prepare for the new level of interoperability and sharing that is reflected in these proposals. The changes in the proposal align closely with the ONC’s Cures Act final rule, which was finalized almost a year ago, with changes that will increase the ability to coordinate care across systems as well as allow patients to access and direct their own care.