Rural hospitals and healthcare clinics have an abundance of headwinds, whether it’s patients with higher rates of chronic conditions or geographic distances. However, one headwind that represents their biggest hurdle is regulation.
State and federal agencies roll out new regulations yearly, and it’s up to organizations to ensure they comply with these mandates. The new regulations often don’t give special dispensation to small and rural providers working to stay afloat — and take effect regardless of whether they have the personnel or the budgets to implement the new mandates.
These regulations may have benefits, from new interoperability-focused standards to incentives for improving patient care and outcomes. They also clarify who must bear the brunt of the cost of development and implementation. However, it’s often challenging for organizations to see the forest for the trees, even when they know the changes are positive.
While rural and smaller clinics and providers must comply with regulations, the biggest question they often ask is how these new specifications impact them.
Health IT Certification Program updates
The Office of the National Coordinator for Health Information Technology’s (ONC) Health Data, Technology, and Interoperability final rule — colloquially called HTI-1 — is the most substantial rule update facing providers. It implements provisions of 2016’s 21st Century Cures Act and updates the Health IT Certification Program.
The new provision aims to promote interoperability among electronic health record (EHR) systems. It mandates algorithm transparency and updates information-blocking requirements to support the accessibility and usage of electronic health data.
While it also establishes first-of-its-kind transparency requirements for artificial intelligence (AI) and other predictive algorithms that are part of certified health IT, the measure clarifies that health IT developers must cover the cost and labor of developing a product.
With such a partnership, these rural clinics can take advantage of these new standards, certification criteria, and quality measures because the burden is put on their partnership through their health IT team. While many providers don’t have the staff to implement these new standards, they can reap the benefits of a trusted partner without taking on cost and workload.
MIPS: Rewarding providers for improving outcomes
The Merit-based Incentive Payment System (MIPS) permits providers to participate in the Quality Payment Program (QPP). The federal program, which started in 2017, reimburses MIPS-eligible Medicare providers for Medicare Part B covered services and rewards them when they improve patient care quality and outcomes.
The program has different reporting tracks: Traditional MIPS and Advanced Alternative Payment Models (AAPMs).
Traditional MIPS, established in the QPP’s first year, is the original reporting option available to eligible clinicians to report data. A provider’s performance is measured across four areas — quality, improvement activities, cost and Promoting Interoperability (PI).
That program is moving toward the MIPS Value Pathways (MVPs) reporting option. It aims to streamline processes and eliminate silos and toward measures and activities that are related.
Groups of similar practices develop specific reporting measures or metrics more applicable to their specialty. Thus, clinics can work with similar providers in their specialty to report these specific metrics.
Interoperability is critical to patient success
The Centers for Medicare & Medicaid Services (CMS) introduced the idea of interoperability in 2011. It gives patients access to their health information when they need it most and in a way they can best use it — regardless of the EHR system their provider uses.
Under QPP, providers submit the quality, PI, and improvement activities that they collect and perform during the performance year. CMS collects and calculates cost measures, and the four performance categories — quality, PI, improvement activities, and cost — are scored and make up the MIPS final score.
That score determines the payment adjustment applied to Medicare Part B claims. They are not necessarily changes but a continuation of the reweighting seen in previous years.
The Cures Act’s most noteworthy requirements may be the U.S. Core Data for Interoperability (USCDI) and the Fast Healthcare Interoperability Resources (FHIR) API mandate. These changes impact how providers — and third parties — can exchange patient data.
While the changes looming on the horizon, particularly interoperability, might seem daunting, providers should recognize they are built on quality data. Accurate and actionable data is the cornerstone of improving the patient experience and outcomes.
There is no debate about the headwind rural providers face. However, providers should not look at new regulations as a hurdle, but as an opportunity to rethink their approach and how they deliver the most value.
That process starts with a purpose-built EHR that creates a single record of truth for each patient and empowers providers to deliver informed and intentional care.
Data analytics can reduce hospitalization and readmission rates while improving outcomes for patients with chronic illnesses. The right system and framework will help smaller providers adapt to new regulations that arise.
No one can predict precisely what regulations will come next. However, putting in place a framework that can evolve over time is critical to preparing for new requirements that are guaranteed to arise. We can’t eliminate regulations, but we can mitigate their burden — and as much as possible, turn the headwinds into tailwinds for rural healthcare providers.
Christina Gutierrez
Christina Gutierrez is Regulatory Project Manager for Azalea Health.
