News & Updates: September 2022
Additional CURES Act Implementation Required by October 6, 2022
In 2016, the 21st Century Cures Act made electronic health information sharing the expected norm in health care by making “Information Blocking” illegal. The Office of the National Coordinator for Health Information Technology (ONC) is the federal agency tasked to implement the Cures Act. The ONC hosts an Information Blocking Portal for patients to report claims that they have been blocked from receiving their electronic health information as defined in the Act.
Implementation Dates:
April 5, 2021: effective date for Interoperability, Information Blocking and ONC Heath IT Certification federal rule linked to 21st Century Cures Act
The “Cures Rule” requires healthcare providers to give patients access to all health information in their electronic medical records “without delay” and without charge.
April 5, 2021 – October 5, 2022: 8 types of clinical notes must be shared to include consultation notes, discharge summary notes, history & physical, imaging narratives, laboratory report narratives, pathology report narratives, procedure notes and progress notes.
October 6, 2022: the definition of electronic health information (EHI) will expand to include all electronic Protected Health Information (ePHI) that the patient has a right to access under HIPAA. HIPAA gives patients the right to access ALL identifiable health information about them in the medical record or stored in other records if it is the type of information used to make decisions about patients.
EHI may include:
  • Medical and Billing records about individuals maintained by or for a covered healthcare provider
  • Enrollment, payment, claims adjudication and case or medical management record systems
  • Other records used in whole or in part by or for the covered entity to make decisions about individuals
December 31, 2022: deadline for all EHR vendors to have new HL7& FHIR API capability and make information in the USCDI Version 1 available to providers
Click hyperlinked headers for ONC source pages.
Healthcare Providers are expected to release all EHI available upon request by the patient without delay, charge or unnecessary impediment.
Providers are not required to release the information prior to a patient request. However, if a patient logs into his/her portal seeking specific information that the practice possesses but has not released to the portal; and the patient asks the practice to provide that information; the practice must do so without delay. 
ONC has specifically noted that information blocking would likely occur if a health care provider delayed fulfilling a patient request for the release of lab or test results for any period of time in order to allow an ordering clinician to review the results or in order to personally inform the patient of the test results before a patient can electronically access such results. This practice does not qualify for the “Preventing Harm” exception.
ONC has noted that non-final clinical information such as draft clinical notes or preliminary test results pending confirmation may not be appropriate to disclose or exchange until finalized. However, if that information is used to make health care decisions about an individual, then it does fall into the definition of EHI that must be disclosed without delay upon request.
Practical Considerations for Physician practices:
  • Confirm that your EHR vendor and your specific EHR version comply with the technical requirements of the CURES Rule.
  • Confirm that you have implemented a workflow to fulfill patient requests for their EHI that complies with the CURES Rule.
  • Confirm that all staff members who process patient requests for their EHI understand your workflow and the urgency of fulfilling those requests in a timely manner.
  • Consider how documentation practices should be updated since patients are entitled to receive ALL information you are storing about them that is used to make decisions unless specifically excluded by the Rule.
  • Ensure staff and providers only record objective and professionally written content in the patient’s record to include notes with “internal” messaging tools.
  • Remind everyone that anything they add to the record may be viewed by the patient upon request with very few exceptions.
  • Evaluate the impact of unfinished notes and voice recognition software errors on the patient’s perception of the practice.
Helpful Resources:
Open Notes is an international movement advocating for greater transparency in healthcare led by Beth Israel Deaconess Medical Center and Harvard Medical School. This website contains excellent resources for Healthcare Professionals that translate the ONC guidance into a more readable format.
The ONC’s Information Blocking website is the definitive source of information on this topic and includes many user-friendly resources. The FAQs are particularly helpful.
AAOS Activity
SCOA Delegation Visits Washington, D.C.
The SC Orthopaedic Association delegation made the rounds in Washington, D.C., earlier this month as part of the combined AAOS NOLC and Fall Meeting to champion the interests of musculoskeletal patients and orthopaedic surgeons in our state. Representatives Wilson, Timmons and Mace personally met with our members. The SCOA delegation also met with staff members in the offices of Senators Graham and Scott and Representatives Norman, Rice and Clyburn.

The SCOA delegation joined AAOS members from all states in advocating four issues: Prior Authorization Reform for Medicare Advantage Plans, Physician Payment Reform, Safety from Workplace Violence in Healthcare Settings, and Ensuring Physicians Lead Care Teams. Particularly encouraging was the House’s passage of H.R. 3173, the prior authorization reform bill, on September 14 – one day after our visit.
Comment Letters to CMS
The South Carolina Orthopaedic Association has joined 39,000 orthopaedic surgeons and residents in signing two recent AAOS letters to the Centers for Medicare and Medicaid Services. One letter provided comments on the Medicare Program: CY 2023 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies, while the other provided comments regarding Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs. Both letters are available below:

Legislative Activity
South Carolina’s general election will be held November 8, 2022. SCOA is particularly interested in the 22 new House members who will fill vacancies created by the addition of new seats, retirement of incumbents, and the defeat of incumbents in the primary election. Ten of those seats will be assumed by candidates who face no opponent in the general election. The graphic below identifies the districts that will have new House members linked to the corresponding Republican and Democratic candidates. The candidates are sorted by geography. 
SCOA members connecting with these candidates before year-end is important. Please let AnnMargaret McCraw know if you have relationships with any of them.

CON Repeal remains a SCOA priority. If that issue matters to you and you have not yet completed this survey, please do so today
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DHEC Regulatory Activity
Notice of Proposed Regulation for Regulation 61-64, X-Rays (Title B) was published September 23, 2022.

Public Comments may be submitted through Monday, October 24 at 5:00 pm via Public Comment form (preferred) or Comments need to reference the section numbers as proposed in the NPR published in the State Register.

Comments received during the official public comment period will be responded to in the drafted Notice of Final Regulation (NFR).
Virtual Stakeholder Meeting: October 11 at 11:00 am via Teams

Notice of Proposed Regulation for Regulation 61-15, Certificate of Need for Health Facilities and Services was published September 23, 2022.

Public comments can be submitted through Monday, Oct. 24, at 5 p.m. via Public Comment Form (preferred) or Comments need to reference the specific regulation section numbers as proposed in the NPR published in the State Register.

Virtual Stakeholder Meeting: Tuesday, October 4 at 10:30 am via Teams
Proposed Regulation 61-15 should not be confused with the CON Statute, which was the subject of the Repeal debate in the spring. Regulation 61-15 outlines the procedures and processes needed for SC DHEC to implement the provisions of the CON Statute: SC Code Sections 44-7-110 et seq. The Regulation cannot change any requirements of the Statute, but modifications can be made to any provisions of the Statute that are delegated to DHEC to design and implement via Regulation.
Leadership Book Nook
What Exceptional Leaders Know &
Exceptional Leaders Playbook
by Tracy Spears and Wally Schmader
The Exceptional Leaders Playbook is great because it's a workbook and asks you to answer insightful questions. I write in pencil, so when I go back and read the workbook again, I can see how my answers have changed from years past. There are so many takeaways. One big one is: “Leadership is a Verb- it is not a position or reward, you can never arrive. Great leaders are defined by what they do, not what they know.” It is more like being a good coach and influencing others to play on your team to the best of their abilities. 
Learning from other good leaders has encouraged me, and something I have said with my team leaders and supervisors is, “People don’t care how much you know, until they see how much you care." Being a humble leader is being someone who accepts responsibility and admits when they're wrong. Humility sometimes can be misconstrued as weakness but it is the opposite. It makes you approachable and your team will want you to succeed. They will see you as empathetic, which allows you to influence others. 
Summary submitted by:
Caressa Lynch, CMPE
Executive Director
A Division of Signature Medical Group of K.C., P.A.
Save the Date!
Webinar Archive
Learn On Your Schedule!
Replay AI in MSK Care Delivery: Potential vs Risk
September's webinar contemplated many uses of AI in MSK delivery. Some are obvious like the use of robotics and remote monitoring tools. Many, however, run in the background supporting other applications you may not consider AI.
When you evaluate any product or service going forward, ask the vendor if AI is incorporated in any way. If so, get the details and share them with your malpractice carrier before making a purchase decision.
Other Past Webinars Include: 
  • Marketing, Social Media, & The Physician Practice: Legal Implications
  • Physician Financial Relationships & Conflict of Interest Policies
  • Online Patient Journey & the Physician Practice Part 1: Reputation Management
  • BRACE YOURSELF with Compliance Tools for Medicare’s new DME Requirements
  • Making MIPS Work for Orthopaedics
  • ​Short-staffed. Short-tempered. Short-timer.
  • And more!
Member Benefit: Discover OrthoEvidence
Our members receive complimentary access to OrthoEvidence (OE), which is the global online source for high quality and timely orthopaedic-only evidence-based summaries, pre-appraised by orthopaedic medical experts.
Thank You To Our Corporate Partner:
South Carolina Orthopaedic Association