April 27, 2018

CMS Proposed Rule CMS-1694-P — Hospital Pricing and Electronic Medical Records: Increasing Patient Access

Holland & Knight Healthcare Blog
Jenna F. Schapiro

On April 24, 2018, the Centers for Medicare and Medicaid Services (CMS) issued for comment a 1883-page proposed rule (CMS-1694-P) (the "Proposed Rule") that aims, among other goals, to increase transparency relating to pricing and electronic medical records at Medicare-participating hospitals.

Specifically, the Proposed Rule requires hospitals to post their pricing lists online, accessible to patients in a "consumer-friendly" way, so that "patients understand what their potential financial liability might be for the services they obtain at the hospital, and to enable patients to compare charges for similar services across hospitals." Effective Jan. 1, 2019, hospitals will be required to "make available a list of their current standard charges via the Internet in a machine readable format and to update this information at least annually, or more often as appropriate." The Proposed Rule specifies that "[t]his could be in the form of the chargemaster itself or another form of the hospital's choice, as long as the information is in machine readable format." According to Health and Human Services (HHS) Secretary Alex Azar, this online public disclosure requirement is intended to reform the Medicare system so that "patients [are put] in charge of their care" and "receive the quality and price information needed to drive competition and increase value." While price disclosure is already required under Section 2718(e) of the Public Health Service Act, the new requirement that this disclosure occur online is intended to improve and increase the accessibility and usability of the pricing information by a wider patient base.

In addition, CMS has proposed certain measures to expand patient access to and interoperability of electronic medical records. Pursuant to the Proposed Rule, the programs formerly known as the Medicare and Medicaid Electronic Health Record Incentive Programs are now referred to as the "Promoting Interoperability Programs" (PIP). PIP provides incentives to providers to revamp their electronic medical records in such a way that patients can easily access their electronic medical records and provide their records to their various providers at various treatment facilities.  The ability to share patient health data in this way is referred to as "interoperability." Beginning Jan. 1, 2019, interoperability will be a major factor in determining hospitals' federal rankings. It has been suggested that the failure to make such interoperability-focused improvements to electronic medical record systems could result in payment penalties in 2021.

Among other points, the Proposed Rule also addresses further reforms to hospital value-based incentives and quality reporting requirements.

Comments to the Proposed Rule will be accepted until June 25, 2018 at 5:00 p.m.

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