Policy Issues
Over the past five years the Institute of Medicine, the Joint Commission, and the Department of Health and Human Services’ Healthy People 2020 initiative have highlighted the health disparities experienced by lesbian, gay, bisexual, and transgender (LGBT) people and recommended the collection of sexual orientation and gender identity (SO/GI) data in order to track and improve LGBT health outcomes. Recently, a number of new federal policy initiatives and regulatory developments have supported the collection of SO/GI data in clinical settings in order to combat LGBT health disparities.
Inclusion of sexual orientation and gender identity in Stage 3 Meaningful Use guidelines
On October 6, 2015, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) took a critical step forward in advancing the health of LGBT people by requiring all electronic health record (EHR) systems certified under the Meaningful Use incentive program to have the capability of collecting SO/GI data. The Meaningful Use program offers financial incentives to health care organizations to encourage them to use EHR technology to improve health outcomes and quality of care. The final rules for Meaningful Use Stage 3 released by CMS and ONC in 2015 require all EHR technology to have the capacity to record, change, and access structured SO/GI data in order to be certified. CMS indicated in the final rule that “CMS and ONC believe including SO/GI in the ‘demographics’ [certification] criteria [for EHRs] represents a crucial step forward to improving care for LGBT communities.”[1]
The ONC notes that the final rules do not require providers to collect SO/GI information. Rather, the requirement applies to vendors who are building certified EHR systems and health institutions and practices that are using these systems as part of their participation in the Meaningful Use program. Even though the rule does not require providers to collect SO/GI data, the CMS final rule notes that giving providers the capability to record and track this data will “help those within the patient’s care team to have more information on the patient that can aid in identifying interventions and treatments most helpful to the particular patient.”[2] Meaningful Use Stage 3 is scheduled to be implemented in 2018.
HRSA’s inclusion of SO/GI in the Uniform Data System for 2016
In March 2016, the Health Resources and Services Administration (HRSA) added SO/GI data as required elements to be reported yearly in the Uniform Data Set (UDS). Each year, health centers funded by HRSA report on their performance using measures defined in the UDS. These health centers provide care to 20 million people a year in the U.S. Beginning in calendar year 2016, health center program grantees will be required to report on SO/GI data collection. In HRSA’s Program Assistance Letter (PAL 2016-2), it stated that “sexual orientation and gender identity (SO/GI) can play a significant role in determining health outcomes,” and that “gaining a better understanding of populations served by health centers, including sexual orientation and gender identity, promotes culturally competent care delivery, and contributes to reducing health disparities overall.”
Center for Medicare and Medicaid Services promotes SO/GI data collection in its 2015 Equity Plan
In September 2015, the Center for Medicare and Medicaid Services (CMS) Office of Minority Health released the CMS Equity Plan for Improving Quality in Medicare. The goal of the plan is to develop innovative solutions that support access to high quality care, promote health care system efficiency, and ensure affordable health coverage for Medicare beneficiaries. One of the major priorities of the plan is to expand the collection, reporting, and analysis of standardized data. Under this priority area, CMS recommends increasing the collection of standardized SO/GI data in order to improve health care delivery and reduce health disparities. The collection of comprehensive SO/GI data is “required to plan for quality improvements, and to address changes among the target population over time.” CMS believes that increasing the collection of standardized data, including SO/GI data, is a critical first step to improving LGBT population health.