Policy & Regulation News

Top 3 Facts About Patient Engagement Policy Requirements

Healthcare professionals must be in the know about patient engagement policy requirements across the industry.

Patient engagement policy requirements are necessary for providers looking to receive incentive payments.

Source: Thinkstock

By Sara Heath

- Patient engagement may be a key factor in the shift toward consumer- and patient-centered care, but it also has an important place in the policy requirements that are driving the healthcare industry.

From the CMS EHR Incentive Programs, MACRA, and value-based care models, healthcare professionals are facing a moral obligation to serve the patient and also a policy obligation.

These programs have implemented rules about data sharing with patients and incorporating the patient into the care team. While there is much overlap between each of these regulatory requirements, industry experts also need to keep track of key facts that distinguish programs from one another.

Patient portals are key in meaningful use

Meaningful use is often given credit for the rise of patient portals. Patient portals are a central patient engagement technology currently employed in clinician offices and hospitals. These tools have reached near 90 percent adoption rates with clinicians, allowing patients to receive access to their own health data.

Since Stage 1 Meaningful Use, for which eligible professionals and hospitals attested in 2010, participants have faced patient engagement requirements. This first leg of the program required eligible professionals to offer patients access to their own health data upon request and to provide an after-visit summary to all patients.

READ MORE: How MACRA, MIPS will Help Deliver Patient-Centered Care

In the hospital setting, participants were required to offer patients electronic access to their own health data upon request. Hospitals were also required to provide electronic after-visit instructions for follow-up care.

Those requirements set the baseline for healthcare professionals to offer patient portal access to patients. Since then, CMS has upped the ante and presented a new set of patient engagement requirements for meaningful use participants.

In Stage 2 Meaningful Use, in which many stakeholders are currently participating, eligible hospitals and critical access hospitals are required to offer digital and unique patient education materials for at least one patient. Hospitals must also allow patients to view, download, and transmit their own health data within 36 hours of hospital discharge.

In Stage 3 Meaningful Use – CMS’ most recent iteration that some stakeholders have begun – participants must attest to one overarching patient engagement requirement. This singular requirement will synthesize certain elements of Stage 2 Meaningful Use regulations and call for use of application programming interfaces (APIs) over which providers can digitally engage with patients.

As healthcare professionals continue to work their ways through meaningful use, they have seen increasing imperatives to use the patient portal and activate patients in health technology use.

MACRA integrates patients into care coordination

READ MORE: How Will MACRA Impact Patient Engagement, Care Coordination?

The Medicare Access and CHIP Reauthorization Act (MACRA) contains two major components: the Merit-based Incentive Payment System (MIPS) and incentive payments for alternative payment models (APMs). Under MIPS, providers face extensive requirements to engage patients as a part of the care team.

MIPS includes Advancing Care Information, which accounts for 25 percent of the MIPS score. As a part of Advancing Care Information, providers receive points for offering patients access to electronic health data and offering electronic patient education information.

The program also works to integrate the patient as a member of the care team. Instead of passively reading digital health information, Advancing Care Information requires providers to engage with patients to activate patients as a part of the care team.

Providers can earn points by encouraging patients to view, download, or transmit their health information, securely message their providers, and contribute patient-generated health data (PGHD). These actions will ideally incorporate the patient into the care team.

Additionally, providers can earn points by encouraging patients to help exchange digital health data between different providers using view, download, and transmit capabilities. This will make the patient a catalyst in care coordination.

Providers can also tap patients in value-based care

READ MORE: Breaking Down the Role of Patient Engagement in Meaningful Use

Advanced APMs, such as certain ACOs and other value-based care reimbursements, are the other component of MACRA. Providers may choose to participate in an advanced APM in lieu of participating in MIPS.

Although there are no concrete patient engagement policy requirements under APMs, they do require an extensive level of patient engagement and patient participation.

Healthcare professionals must ensure that patients are working within the parameters of the APM to meet the capitated payment parameters. Engaging patients in wellness behaviors is an important strategy in delivering care within the confines of the APM.

Healthcare professionals must also use population health management to guide patients through the APM. Addressing the social determinants of health will help providers keep patients healthier in the long-run, reducing costs associated with catastrophic medical intervention.

It is true that patient engagement is a moral obligation for healthcare professionals and cannot always be prescribed. Providers want to offer a positive patient experience, deliver care that is dignified and respectful, support patients accessing healthcare, and meet patient needs and preferences.

However, in pursuit of those ideals providers must also be cognizant of the regulatory requirements. While meeting these requirements may often seem arduous, they are a means toward an end in patient engagement.

Requirements in meaningful use and MIPS will support patient adoption and engagement with patient portals and other technologies. Requirements for value-based payments and APMs will offer a financial imperative for providers to drive population health management and patient outreach.


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