AHA and MGMA say vendor penalties in final rule for blocking information are ‘excessive’
Two health care provider groups, the American Hospital Association and the Medical Group Management Association, have both responded critically to the Department of Health and Human Services’ statements. just released final rule on blocking information disincentives.
In separate statements on Monday, AHA and MGMA said they are “disappointed” that HHS has imposed substantial new penalties on covered entities that it determines have disrupted the access to, exchange or use of electronic health information.
While both organizations have long said they support information blocking rules that govern the interoperability of patient health information, they are concerned that excessive fines could negatively impact practices, accountable care organizations and Medicare patients.
WHY IT MATTERS
Medical groups already face reporting issues under the Merit-Based Incentive Payment System, which has 15,000 medical practice group members ranging from small private medical practices to large national health care systems with 350,000 physicians, according to the MGMA.
“By imposing a zero-point penalty in the Promotion of Interoperability category, this rule ensures that offending groups are likely to receive a negative payment adjustment on each Medicare claim for an entire payment year,” the Medical Group Management Association said in its report . response statement on Monday.
Any provider found to have blocked information will receive a score of zero for the MIPS Promoting Interoperability requirement, putting its revenue at risk.
“As a result, the health care provider may not receive revenue that it would otherwise have earned through the Shared Savings Program,” HHS said in its report. announcement about the last rule.
Some exceptions would allow providers to deny a request for access to EHI without incurring a penalty. To understand them well enough, however, providers must have undergone significant training, industry experts say since the proposed rule was made available for public comment late last year.
MGMA and AHA have called for education and resources to guide providers in avoiding costly missteps in navigating the complexities of the exceptions. In April, ONC released a fact sheet to explain the exceptions and previously held webinars on exceptions to information sharing.
Disentangling which certified healthcare IT developers and providers are responsible in an information-blocking referral investigation could also create complexity for the HHS Office of Inspector General.
But if an OIG investigation finds that individuals or entities blocked information, the providers involved could face civil penalties of up to $1 million per violation, according to an OIG investigation. rack from the American Medical Association in February.
“Providers in accountable care organizations who block information will be ineligible to participate in the Medicare Shared Savings Program for at least one year and may not receive any revenue they may have earned through the program,” the AHA said in the report released today . response.
The disincentives, with their narrow focus, will do little to support broader interoperability and greater access to health information, the Electronic Health Record Association said.
“HHS continued to focus only on certified healthcare IT users in this final rule, omitting a significant list of other stakeholders, such as laboratories and providers that do not participate in MIPS but are nevertheless central to the exchange of healthcare information ” said Leigh Burchell of Altera Digital Health, Vice Chair of the EHRA Information Blocking Compliance Task Force.
“A more inclusive approach to disincentives could motivate a broader range of healthcare providers to embrace best practices for information sharing.”
Both ONC and CMS will need to do more to educate about the final rule, she added.
“It is clear that the biggest obstacle to compliance today is a lack of awareness of the requirements among hospitals and physician practices.”
The final rule will become effective 30 days after publication in the Federal Register on June 24.
THE BIG TREND
Negative incentives are largely aimed at providers participating in CMS programs, which some organizations, such as the American College of Radiology, argue is the appropriate mechanism to discourage providers.
However, providers involved in the MIPS and Promoting Interoperability Program and accountable care organizations already adhere to the interoperability requirements of certified EHR technology through their CMS program obligations, the Electronic Health Record Association said in its comments to the agency.
In January, several organizations, including MGMA and EHRA, released their comments on the proposed federal rule to the Office of the National Coordinator for Health Information Technology, the Centers for Medicare & Medicaid Services, and the Office of the Inspector General.
They called for a tailored approach to the barriers to interoperability required under the 21st Century Cures Act.
“CMS could consider issuing the disincentive as a negative payment adjustment for the first violation, and then providing education and resources on how to comply with information sharing requirements instead of posting the party on the website that blocks information,” according to the Health Information Management Systems. Company, parent company of Healthcare IT newssaid in his commentary.
ON THE RECORD
“HHS could have chosen to work with health care providers to implement corrective action plans, but instead administered unnecessary punitive penalties that will financially harm practices and negatively impact Medicare patients,” MGMA said in a statement.
“AHA is disappointed that HHS has chosen to ignore most of the comments they received and is deeply concerned that the dissuasive structure established in the final rule is excessive, confusing and unbalanced,” the organization said in a separate statement.
Andrea Fox is editor-in-chief of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.