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Interoperability and Patient Access Final Rule

The Centers for Medicare & Medicaid Services finalized the Interoperability and Patient Access final rule which establishes the commitment to ensuring seamless data exchange between provider organizations and patients for better outcomes. One component of the final rule is the new requirement for hospitals – including critical access and psychiatric hospitals – to send electronic patient event notifications for admissions, discharges and transfers to PCPs, post-acute providers and other community providers as part of the Conditions of Participation (CoPs).

Although the timeline for implementing the requirements was recently extended to spring 2021, it’s critical to understand the facts:

  • Hospitals with an EHR that can generate ADT messages must send patient event notifications for inpatient, emergency department, and observation admissions and discharges, and for any transfer events to another level of care.
  • Event notifications must be sent in near real time and include patient name, treating practitioner name and sending institution name.
  • Hospitals should send event notifications to an established primary care physician, practice group or post-acute care provider or supplier.

Hospitals are allowed to partner with intermediaries to reduce the burden of fulfilling CoP requirements and complying with regulations. Furthermore, intermediaries can help:

  • Deliver notifications to an established network of post-acute providers nationwide through existing solutions
  • Match patients more effectively
  • Tailor notification preferences to individual provider organizations to reduce “notification fatigue” or only provide alerts requested by that organization
  • Provide additional clinical context and actionable information to further help the coordination of care between providers
  • Extend the value of the notifications by involving various stakeholders – including ACOs – to optimize emergency department utilization, bill for TCM services and improve the quality of care

Download our on-demand webinar with associates from Foley Hoag to learn more about the rule and how hospitals can comply with the new CoP, and read our press release on how CarePort supports CMS’ expanded commitment to care coordination.







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