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CMS Opens Up Data to Businesses in Bid to Spur Innovation

By Mohana Ravindranath // June 2, 2015

Acting CMS Administration Andy Slavitt
Acting CMS Administration Andy Slavitt // Evan Vucci/AP

The Centers for Medicare and Medicaid Services is actively encouraging businesses to build better technology -- using the agency's data.

In a keynote address during the annual "Health Datapalooza" in Washington on Tuesday, acting CMS Administrator Andy Slavitt announced CMS was for the first time giving businesses access to CMS data, previously only granted to researchers.

Leaders at the Department of Health and Human Services hope these groups can come up with technology that might improve care, possibly by helping health care providers make personalized decisions based on individuals’ data, Slavitt said.

“In taking this step, we are challenging others with proprietary data to follow our lead,” he said.

The agency also plans to update its health data for researchers and businesses more frequently, and in a more machine-readable format, Slavitt added.

“In an information age, it is just not acceptable that the most recent Medicare data available is from 2013," he said.

Slavitt reminded researchers and businesses who are analyzing data to prioritize patient privacy, noting, “progress will simply not be possible without consumer trust.”

HHS Cracks Down on Hospitals Hoarding Patient Information

By Mohana Ravindranath // April 10, 2015

Brian A Jackson/Shutterstock.com

It could be years before patients move freely between health care systems followed seamlessly by their electronic health records.

Are technology developers -- and big health care conglomerates -- to blame?

The Department of Health and Human Services' Office of the National Coordinator for Health IT is paying special attention to health systems engaging in “information blocking" -- knowingly, and sometimes "unreasonably," interfering with the exchange of information.

On Friday, ONC issued a report to Congress about allegations that health care providers and IT developers are working to block the exchange of patient information, especially to competitor health systems.

For instance, larger hospital systems are less likely than smaller ones to exchange electronic health information externally with competing hospitals and unaffiliated providers, the report found. Hospitals that have “invested significant resources internally to deliver more valuable care” could be less likely to exchange information with unaffiliated providers.

ONC compiled the report based on complaints to HHS. During a conference call Friday, agency heads acknowledged there isn’t yet much quantifiable information about the practice.

Most complaints about information blocking are directed at health IT developers, the report said -- developers sometimes charge fees for customers (health care systems) to send, receive or export electronic...

Senators Want to Speed Adoption of Electronic Health Records Systems

By Mohana Ravindranath // March 18, 2015

Brian A Jackson/Shutterstock.com

It could be years before patient health records flow seamlessly between hospitals, despite federal and state efforts to encourage information exchange. Earlier this week, lawmakers asked representatives from the private sector how they could speed up that process.

The federal government has invested about $30 billion in Medicare and Medicaid incentive programs that reimburse health care providers if they install electronic health records systems, and if they demonstrate that those systems improve the quality of care. Starting in 2015, eligible providers could see their reimbursements reduced -- a form of a penalty -- if they don’t demonstrate so-called “meaningful use” of their EHR systems.

During a hearing at the Senate Committee on Health, Education, Labor & Pensions, chairman Sen. Lamar Alexander, R-Tenn., asked witnesses what could be preventing hospitals and health care providers from adopting EHR systems.

So far, he noted, about 48 percent of physicians and 59 percent of hospitals have at least a basic EHR system in place. (The Defense Department is currently reviewing bids for a potentially $11 billion, 10-year revamp of its own health records, with bids from tech companies including IBM and Epic, as well as Leidos and Accenture Federal.)

For some, said Robert Wergin, president of...

Are Medicaid IT Systems the Weak Link in Detecting Improper Payments?

By Mohana Ravindranath // March 10, 2015

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States aren't doing enough to prove that their Medicaid information systems can detect improper payments -- for medically unnecessary treatments, services not covered by Medicaid or services billed for but never provided, according to a new Government Accountability Office report. 

The Centers for Medicare and Medicaid Services estimated that $14.4 billion -- 5.8 percent -- of Medicaid payments in 2013 were made improperly, but states still don't have a good system for reporting on how their information management technology is helping track the flubbed payments, GAO said. Medicaid is a joint federal-state program providing health care coverage to low-income patients, overseen by CMS within the Department of Health and Human Services.

The 10 states GAO examined had systems in place for managing Medicaid claims -- some implemented more than 20 years ago -- but the "effectiveness of the systems for program integrity purposes is unknown," the report said.

Only three states examined had established ways to measure the financial benefits of their systems in preventing and detecting improper payments -- how much money was saved or recovered -- according to the report, which analyzed quarterly data from the Medicaid administrators.

With expenditures of about $460.3 billion in fiscal 2013, Medicaid covered about...

GAO: CMS Isn't Doing Enough to Address HealthCare.gov Failures

By Mohana Ravindranath // March 5, 2015

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Despite attempts to address HealthCare.gov's technical failures -- the crashes and response-time lag, among other issues -- the Centers for Medicare and Medicaid Services hasn't fixed underlying flaws in the IT management process, a new report finds. 

In a performance audit of the agency, conducted between December 2013 and March 2015, the Government Accountability Office concluded that CMS still shows deficiencies in systems testing, oversight and the management of requirements for IT projects, more than a year after HealthCare.gov's October 2013 launch. 

CMS began implementing new IT governance processes in June 2014, but they're not fully in place, the report said. For instance, though a new process calls for sign-off on certain requirements from a CMS business partner, a CMS approving authority, and a contract organization's approving authority, only one of 18 documents related to the federal insurance marketplace had all the necessary approvals, GAO found.

It wasn't clear from documents which requirements were being approved, the report said -- while some pages were scanned and uploaded to an agency project management system, 10 of 18 signature pages were not linked to documents specifying the requirements being approved.

In one case, 84 percent of the...