“Are we there yet?” It’s a familiar refrain for families taking a summer roadtrip. But the meandering road to healthcare interoperability leaves providers, payers, and patients questioning how long this journey will take. Evolving health tech regulations and standards could fuel progress on interoperability, prior authorization automation and more. What do you need to do to stay on the right track? 

1. Improve price transparency

The price transparency final rule went into effect in January 2021, but until recently, the CMS has relied on warning letters rather than stronger enforcement tactics. That changed this month with the recent fines levied against two of the five facilities in a Georgia hospital system. 

The pair of fines exceeded $1 million, signaling that the CMS is prepared to play hardball. According to a JAMA study analyzing 5,200+ hospitals, a lot of providers will need to step up to the plate or face similar financial risk. Only 6% of the hospitals met the regulations standards: a machine-readable price file AND a consumer-friendly display of prices for 300 common services. 

Providers also have to answer to patients—and they want price transparency too. In fact, 83% of healthcare consumers want an accurate estimate of out-of-pocket costs before an episode of care. Myndshft makes it possible, using providers’ contracted rates and patients’ exact benefits to automatically calculate patient financial responsibility at the point of care. By meeting this need for patients, you deliver better experiences while increasing collections at the time of service. 

2. Prepare for interoperability

Interoperability is coming. It has to, if only to make compliance with existing health tech regulations more achievable. The No Surprises Act, for instance, has an as yet unenforced “convening providers” rule requiring providers to anticipate additional care a patient may require and gather cost estimates from other providers so patients can make informed decisions. 

In a letter to the CMS, the American Hospital Association (AHA) urged a delay in enforcement until a more standardized process is available. Currently, the lack of interoperability amongst providers and with payers means more manual effort when resources are already strained and time is of the essence.

The AHA believes that moving forward without a standardized process will “inevitably lead to widespread variance throughout the industry (particularly given the differences in size and levels of technical sophistication among co-providers and co-facilities),” reports Healthcare Dive. 

What can help you prepare? Move toward solutions that are designed to make information exchange secure, accessible and standardized. Myndshft, for example, enables the entire patient intake process from benefits verification to prior authorization automation using HL7® FHIR® (Fast Healthcare Interoperability Resources) APIs (Application Programming Interfaces). These APIs enable seamless healthcare information exchange of both clinical and administrative data, moving us one step closer to value-based care. 

3. Keep an eye on your calendar

Currently, the information blocking regulation introduced by the Cures Act covers only the U.S. Core Data for Interoperability: 

• Allergies and Intolerances
• Assessment and Plan of Treatment
• Care Team Member(s)
• Clinical Notes
• Patient Goals
• Health Concerns
• Immunizations
• Laboratory
• Medications
• Patient Demographics
• Problems
• Procedures
• Provenance Metadata
• Smoking Status
• Unique Device Identifier(s) for a Patient’s Implantable Device(s)
• Vital Signs

But on October 6, 2022, the definition of EHI (Electronic Health Information) subject to the information blocking regulations will expand to include the HIPAA designated record set, which covers both clinical, insurance, and billing information. Because of this, providers and payers will need better interoperability, fast. 

And that’s just one piece of the Cures Act, which promotes patient access to health information through API adoption. API certification is another key component to ensure that safety, security and affordability are addressed as well.  

Referencing the Cures Act, Micky Tripathi, national coordinator for health information technology, promises in a Health Affairs article that “This year providers, patients, payers, public health practitioners, technology developers, researchers, and other stakeholders will take the decade-long investment in health information technology to the next level.” 

So, no, we aren’t there yet, but we’re getting closer.  Find out how Myndshft can help you on the journey.