CMS Announces New Pilot Program to Support Providers With More Complete Medicare Claims Information

August 2, 2019

The Centers for Medicare & Medicaid Services (CMS) recently announced a new voluntary pilot program that will give select providers access to Medicare claims data staring in January 2020. The “Data at the Point of Care” (DPC) pilot, which is part of the MyHealthEData Administration-wide initiative led by the White House Office of American Innovation, will allow participating providers to fill in information gaps by providing access to structured and complete claims data, including previous patient diagnoses, past procedures, and medication lists. Medicare beneficiaries give permission for this data to be shared in their early sign-up for Medicare and can always opt-out of their claims data being shared.

Clinicians will be able to access the data directly within their workflow, without needing to log into another application, increasing the potential to save time on administrative tasks in the exam room and allow providers more time with their patients. 

“Technology, coupled with open data sharing, is how we will improve value, control costs and keep patients healthy while ensuring a solvent Medicare program for generations to come,” said CMS Administrator Seema Verma, in announcing the DPC pilot.

CMS also noted that the lack of interoperability in the health care field has been a key issue for providers and patients alike, and there is currently no system in the United States that allows patients to access their complete health information aggregated into one usable health record. Without access to a consolidated medical history, doctors are often left to offer treatment solutions based on incomplete information, putting patients at risk and potentially duplicating tests and treatments that can be costly or unnecessary.

To help close this gap, ASCO, its wholly owned nonprofit subsidiary CancerLinQ LLC, the MITRE Corporation, and the Alliance for Clinical Trials in Oncology Foundation have established a core set of data elements and recommended technical specifications (the Minimal Common Oncology Data Elements, or “mCODE”) that are essential for capturing and reporting the characteristics, treatments, and outcomes of every cancer patient and should be contained in each patient’s electronic health record (EHR). The mCODE™ initiative released the initial set of common cancer data standards in early June and published them online at mCODEinitiative.org.

Providers who are interested in participating in the DPC pilot program can sign up on the CMS website.

For more information on ASCO’s work to promote electronic health record interoperability, bookmark ASCO in Action.