Payers Convene for CMS Interoperability Rule, ADT Infrastructure

The United States QHIN (USQHIN) has launched a payer advisory workgroup (PAW) to guide the National ADT Hub Network (NAHN) in the creation of a national interoperability infrastructure for admission, discharge, transfer (ADT) messaging. The workgroup will ideally support compliance with the CMS interoperability rule.

As a sub-group of the NAHN, the PAW will gather ongoing input from national health payers regarding the creation of a national ADT messaging infrastructure.

“USQHIN is fostering important conversations around healthcare, addressing the issues facing the industry at large and dedicated to convening solutions,” Doug Dietzman, executive vice president of USQHIN, said in a press release.

“The NAHN brings health information exchange (HIE) organizations and ADT service providers across the country together to make ADT data ubiquitous, while increasing the quality of the data being exchanged,” Dietzman continued.

The CMS Interoperability and Patient Access final rule requires provider organizations to demonstrate that their EHR system can send patient event notifications to all applicable post-acute care providers through the ADT messaging standard. This includes primary care practitioners and groups, and other practitioners and groups identified by the patient as primarily responsible for her care.

These notifications aim to promote care coordination by keeping a patient’s care team updated about care events for appropriate follow-up. ADT alerts are also expected to reduce readmissions, improve provider-to-provider communication, boost post-discharge transitions, and support patients with multiple conditions.

However, industry stakeholders have noted that while the final rule outlines expected ADT message transfer specifications, it doesn't clearly describe how healthcare organizations are going to connect to send and receive the messages.

NAHN aims to address this compliance barrier through the creation of a national interoperability infrastructure for ADT messaging. PAW input is set to advance the network’s mission.

“We are excited to form the PAW because payers play a critical role in this conversation,” Dietzman noted.

PAW members will also support NAHN’s efforts to increase ADT message data quality to support a more standardized nationwide infrastructure.

“The Payer Advisory Workgroup is an important component of the work that USQHIN is doing surrounding the National ADT Hub Network,” said Tim Pletcher, DHA, executive director of the Michigan Health Information Network Shared Services (MiHIN), one of the founding members of NAHN.

“The PAW will further supplement these efforts by gathering information directly from large health plans to leverage and align their incentive structures to better enable high quality ADT message flow,” Pletcher continued.

PAW expectations include attending monthly one-hour meetings, providing insight on the specific value propositions and various health plan ADT data requirements from the NAHN asset, and giving input on NAHN’s business and operating model.

USQHIN launched the NAHN in February during the height of COVID-19. NAHN participants, also known as “gateway partners,” are expected to provide data into the network and participate in a future revenue sharing program.

“Each of the collaborating Gateway Partner organizations plays an important role in making ADT data actionable for those they serve across the country at local and regional levels,” Dietzman said in a statement at the time of the announcement.

“But no single entity has all the ADTs in the country to meet the needs of federal public health agencies or other large national entities. By working together, the NAHN promises an end result that is greater than the sum of the parts,” Dietzman explained.