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August 5, 2019

How Medicare wants to help doctors fill in the gaps in patients' medical histories

Daily Briefing

    CMS on Tuesday unveiled a new pilot program intended to help providers fill gaps in a patient's medical history by giving them access to Medicare claims data.

    About the pilot

    CMS said the pilot is part of the agency's MyHealthEData initiative. But while previous MyHealthEData projects, such as Blue Button 2.0, focused on connecting patients with their medical information, the new pilot, called Data at the Point of Care (DPC), aims to help doctors provide high-quality care.

    CMS said, "[P]atient information often becomes trapped within health system siloes," and as such "[d]octors are left offering treatment solutions with incomplete patient histories, putting patients at risk and potentially duplicating tests and treatments that can be costly or unnecessary."

    Under the pilot, providers who volunteer to participate will be able to request a Medicare beneficiary's claims data from CMS through an industry-standard API that interacts with their existing electronic health record system or other point-of-care tools.

    CMS said the Medicare claims data will give providers "a more structured and complete patient history with information like previous diagnoses, past procedures, and medication lists." CMS said the agency expects direct access to Medicare claims data "will reduce burden in the exam room and give clinicians more time to deliver high quality care for their patients."

    Pilot rollout

    CMS officials said providers can begin to sign up for the pilot program now, but the program will not officially launch until January 2020. CMS officials said the agency will begin offering test data to a few providers in August and plans to test production data in September and October.

    CMS Administrator Seema Verma said the program will "start out small and build up," but did not say how many providers she expect to participate nor whether the agency will cap the number of participants.

    Officials said the agency will gradually allow more providers to participate in the pilot and plans to continue to test and enhance the program's workflow over the course of several months. Officials said the agency eventually plans to allow all fee-for-service providers to participate in the program, but they did not provide a timeline for when CMS would expand the program (Landi, FierceHealthcare, 7/30; Clason, Roll Call, 7/30; Cohen, "Transformation Hub," Modern Healthcare, 7/30; CMS release, 7/30; Cirruzzo , Inside Health Policy, 7/30 [subscription required]).

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