2023 Regulatory Updates: A Look Ahead
The healthcare initiatives within the 21st Century Cures Act (Cures Act) appear like a scattered puzzle. The act aims to help with electronic health records and create a standard of interoperability. Several recent pieces of digital technology are on the table waiting to be put together and each defines a distinct component of healthcare from technology, patient needs, and streamlined workflows. The Cures Act serves as a segment of the larger healthcare puzzle with additional pieces of legislation fitting into the larger healthcare puzzle.
The 21st Century Cures Act
As the components of the Cures Act shift from policy to practice, increased patient access requirements bring new questions regarding privacy for patients. The goal of the Cures Act is to advance interoperability and compliance while also maintaining privacy, and these functions represent the duality of two important components for current practitioners and many healthcare roles. All players in the healthcare space must comply with the Cures Act’s information-blocking requirements, from providers to payers to health IT developers like Greenway.
A critical piece of this compliance for Greenway in 2022 was ensuring the roll-out of our Cures-compliant product versions, now available on the Certified Health IT Product List (CHPL). Updated Electronic Health Record (EHR) versions include the latest data elements that must be able to be provided electronically to patients at no cost to them. Coordination with your health records between offices, cities, and providers makes for a more informed treatment plan and may cut down on errors.
“In 2023, Greenway will continue to evolve our products to meet increasing Cures requirements around electronic health Information (EHI) export and our top priority is to make sure our clients understand what is required of them, and what compliance with the Cures Act using Greenway products can look like,” says Stephanie Jamison, Senior Director of Regulatory and Government Affairs for Greenway Health and an Executive Committee member of the Electronic Health Record Association. Greenway products and services, including the resources found within the Greenway Cures Academy will continue to evolve to meet the ever-changing needs to maintain quality.
Health data privacy and transparency
In this new landscape shaped by the Cures Act, questions about patient access and privacy issues will continue to be worked through as the industry adjusts to new expectations around what is required when patients request their electronic health information. Questions around adolescent and pediatric care, proxy/patient access, and behavioral health remain unsolved.
The Office of the National Coordinator (ONC) has repeatedly stated its intent that Cures Act does not circumvent Health Insurance Portability and Accountability (HIPAA)and that providers must consider federal and state laws when considering these important topics. Over time, the ONC will oversee how changes are used in the healthcare system.
Also, as of January 1, 2022, the No Surprises Act helped protect consumers from unplanned medical bills. Under the No Surprises Act, providers must provide a Good Faith Estimate for consumer care in advance, and if a patient later receives a bill that is higher than this first estimate, the patient has the right to dispute it. Currently, Good Faith Estimates only need to be provided to uninsured patients, however, the government is currently engaging in rulemaking around instituting these measures for insured patients in the future.
Telehealth expansion wins and updates
Care and convenience dominate many consumers’ decisions when looking for healthcare. The Health and Human Services Department has extended the Public Health Emergency (PHE) for several more months until April 2023 but is widely expected to end after that time. Telehealth services flourished during the pandemic, and consumers often enjoyed the convenience of home-based appointments. For those living in rural or remote areas, or those with mobility issues, telehealth is life-altering and inspiring for recovery. Telehealth is often used for prescription refills, follow-ups, mental health counseling, and more.
In 2023, Medicare patients will be able to receive mental health treatment remotely and in audio-only formats, and certain telehealth services were set to be phased out at the end of the PHE. However, in the year-end Omnibus spending bill in December 2022, language was included by Congress to allow many Medicare telehealth provisions to remain for two additional years past the PHE through December 31, 2024. These include provisions for Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs).
Currently, allocations for telehealth include:
- Expanding originating site to include any site at which the patient is located, including the patient’s home;
- Expanding eligible practitioners to furnish telehealth services to include occupational therapists, physical therapists, speech-language pathologists, and audiologists;
- Extending the ability for federally qualified health centers (FQHCs) and rural health clinics (RHCs) to furnish telehealth services;
- Delaying the six-month in-person requirement for mental health services furnished through telehealth, including the in-person requirements for FQHCs and RHCs;
- Extending coverage and payment for audio-only telehealth services; and
- Extending the ability to use telehealth services to meet the face-to-face recertification requirement for hospice care.
Health equity looms large
Services for healthcare outside of a typical office can also play a role in health equity, and health equity can include areas beyond healthcare, such as education, social, and economic factors. Technology is still required for telehealth and the beginnings of any health equity. Health equity can be impacted by a lack of access or other factors.
“Only about 20% of one’s health outcomes are related directly to one’s healthcare,” according to Dr. Blackman, Chief Medical Officer for Greenway Health. “The other 80% is what people commonly refer to as social determinants of health.”
There are often underlying sectors, according to Dr. Blackman, such as behavioral health, i.e., life stressors, lack of access to fresh foods, mental health issues, or even addictions, which may prevent some individuals from reaching their full health potential. Whenever providers and practices can bring together healthcare guidance and social determinants of health -- patients win.
By taking advantage of every interaction with the patient to account for potential social determinants of health (SDOH), patients can receive better care and better outcomes for their long-term health. For example, a patient and their provider may need more appointment time if the individual falls into a higher risk category for certain diseases or illnesses. Through a tailored plan with specific needs for each appointment and accounting for nuances of personalized health plans, success follows. Thorough scheduling and reminders may even save lives.
With a focus on outcomes, Greenway Health serves as a partner in healthcare products and services ensuring an entire practice and its technologies work together seamlessly. Software aimed at objectives such as reducing costs or improving patient outcomes matter for a business's overall quality and performance. As an example, the software may set important checks and improve customer satisfaction thereby improving the health of entire populations.
With regulatory mandates and quality measures that bring items into common usage for a given community such as lead water screenings or diabetes early detection screenings, Dr. Blackman believes technology must uncover signs and trends to discover the impacts SDOH can have on patients and assist in providing quality goals for a given community.
These factors are currently being built into software and automation processes to alert providers of potential risk factors.
“The goal is to have improved outcomes; we must look at healthcare in its totality,” says Blackman.
Conclusion
Patient privacy rights, adolescence/pediatric care, health data, privacy, telehealth, and overall health equity concern us all on a global level. Specifically, in the United States, new mandates along with improved technologies of screening, automation, and scheduling may help providers and patients demand a higher level of care. Care, convenience, legal provisions, and the evolution of telehealth are essential areas to consider for consumers and providers. These are available in fully bundled, cloud-based solutions. Find out how these changes and Greenway Health’s solutions work together to improve care.
