EHR ven­dors make pitch for eas­ing Stark rules

Modern Healthcare - - News - By Rachel Z. Arndt

MAK­ING A CASE for mar­ket-driven in­ter­op­er­abil­ity, Athenahealth has asked the CMS to let physi­cians pay each other for ex­chang­ing pa­tient data.

Health­care lacks in­ter­op­er­abil­ity not be­cause of tech­no­log­i­cal prob­lems but be­cause of busi­ness lim­i­ta­tions, ac­cord­ing to the com­pany.

Athenahealth’s novel sug­ges­tion was part of a slew of com­ments the in­dus­try sub­mit­ted to the Of­fice of In­spec­tor Gen­eral, which asked for ideas on how to al­ter Stark and anti-kick­back fraud and abuse laws, which pro­hibit one provider from mak­ing cer­tain re­fer­rals to an­other provider if the two have a fi­nan­cial re­la­tion­ship.

If the CMS made carve-outs to the laws, it could help es­tab­lish a “true func­tion­ing mar­ket for the ex­change of health in­for­ma­tion,” Greg Carey, Athenahealth’s di­rec­tor of gov­ern­ment and reg­u­la­tory af­fairs, wrote in a let­ter to the OIG.

Carey cited fi­nance, in­sur­ance, and auto parts as in­dus­tries that al­low their play­ers to pay for data. “It is our ex­pe­ri­ence that in­for­ma­tion ex­change oc­curs best when there is a busi­ness case and prob­lem to solve,” Carey wrote.

Ex­chang­ing in­for­ma­tion is costly, ac­cord­ing to the com­pany. “There is a cost as­so­ci­ated with build­ing and main­tain­ing the tech­ni­cal in­fras­truc­ture,” Carey told Mod­ern Health­care. “Our pro­posal would al­low for the re­cip­i­ent of valu­able data to com­pen­sate for the real cost in­curred in cu­rat­ing and send­ing that data elec­tron­i­cally.”

But how that would look in prac- tice re­mains to be seen. “I’ve seen no ev­i­dence that providers are hes­i­tant to share clin­i­cal data be­cause of a kick­back con­cern,” said Michael Burger, se­nior con­sul­tant for Point of Care Part­ners. Athenahealth’s strat­egy could even back­fire, he said. “By plac­ing a cost on shar­ing of clin­i­cal data, what if the doc­tor doesn’t want to pay? Per­haps they would go with­out the data,” he said. “Or they may just say, ‘fax it to me.’”

The real busi­ness prob­lem, he added, is that health sys­tems don’t want pa­tients go­ing to out­side providers.

In its let­ter to the OIG, Cerner Corp. asked the CMS and OIG to write into the EHR Safe Har­bor that providers in Ad­vanced Al­ter­na­tive Pay­ment Models be al­lowed to donate and re­ceive “elec­tronic health record items and ser­vices,” in­clud­ing pop­u­la­tion health man­age­ment and care co­or­di­na­tion tools.

Sim­i­larly, the Col­lege of Health­care In­for­ma­tion Man­age­ment Ex­ec­u­tives asked the OIG to al­low providers to donate cy­ber­se­cu­rity tools, es­pe­cially to

● smaller provider or­ga­ni­za­tions.

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