Responding to CMS' Interoperability Rule, AMGA Says Providers Still Need Access to Claims Data

Responding to the Centers for Medicare & Medicaid Services (CMS) final rule on interoperability and patient access that dropped earlier this week, the AMGA said while it appreciates CMS’ efforts to empower patients to access their own data, providers still need seamless access to this information to care for their patients.

Per the final CMS rule, one of two government-issued final rules on interoperability that were released on Monday, health plans operating Medicare Advantage, Medicaid, the Children’s Health Insurance Program (CHIP), and Affordable Care Act (ACA) exchange plans will be required to share claims data electronically with patients through an application programming interface (API).

In its release of the final rule, CMS admitted that claims data, used in conjunction with clinical data, “can offer a broader and more holistic understanding of an individual’s interactions with the healthcare system, leading to better decision-making and better health outcomes.” As such, these payers are required to implement the patient access API beginning Jan. 1, 2021.

But AMGA, a trade association representing multispecialty medical groups and integrated systems of care, said in statement attributed to the group’s President and CEO, Jerry Penso, M.D., “Provider access to patient data is required in a system where organizations agree to be held accountable for the cost and quality of care for a defined population.”

Penso continued, “AMGA’s members strongly believe in population health and the move to value-based care as a means to create a healthier society. Access to claims data allows our members to continue this shift and provide high-quality care to the communities they serve.”

AMGA noted that it’s continuing to work with key House and Senate leadership to secure support for legislative action to ensure that providers have access to patients’ claims data. Section 501, which was a part of the Lower Health Care Costs Act, would require payers to share claims data with providers.

According to AMGA, “This section would be the last crucial link to ensuring patients and providers have complete information and would complement the ONC and CMS efforts.”