CMS-based disincentives jeopardize info blocking participation, says MGMA

The Medical Group Management Association this week called for more transparency from the Office of the National Coordinator for Health IT in its proposed information blocking rules — and outlined a number of key recommendations to ease the burden on healthcare providers.

WHY IT MATTERS

“More clarity is needed on how the program works, the applicability of exceptions, and how it intersects with state law,” MGMA said in its report. letter Tuesday.

Several organizations have asked ONC to work with other federal agencies to ensure a more cohesive strategy for sharing patient information. They expressed the need for healthcare providers to receive technical assistance to protect privacy and security while ensuring interoperability.

“While we recognize the need for ONC and (Centers for Medicare & Medicaid Services) to establish appropriate barriers to providers blocking information under the 21st Century Cures Act, we have significant concerns about the proposed rule and its impact on medical groups,” he says. the MGMA said.

Instead, the medical group's membership organization is proposing a corrective action process that would resolve allegations of information blocking without the threat of financial penalties that would prevent providers from participating in Medicare.

“Properly allowing providers to correct abusive behavior through the use of education and guidance would best facilitate information sharing,” the organization said.

MGMA also pushed for what it called a simple appeals process that ensures due process considerations to address a situation where they are wrongly accused of blocking information “without suffering significant financial harm”, and asked ONC for the category promotion of interoperability under the Merit criteria. -based incentive payment system.

Advancing interoperability performance makes up 25% of MIPS's annual score, and any finding of information blocking would impact an eligible physician's meaningful EHR user status for a single reporting period.

“There is only one penalty per year,” even with additional referrals for the same period, said Elizabeth Holland, CMS senior technical advisor, during a webinar on blocking exceptions hosted by U.S. Health and Human Services in November.

According to MGMA, this is little consolation for smaller providers.

“The substantial administrative burdens and challenges faced by medical groups under the MIPS program will be exacerbated if agencies continue with this punishment,” the organizations said.

Similarly, the organization said removing accountable care organizations and providers participating in ACOs from the Medicare Shared Savings Program would erode value-based care.

“Significant” administrative and financial barriers run counter to agencies' intentions to promote VBC and “undermine providers' ability to succeed in MSSP,” MGMA said.

THE BIG TREND

The proposed information blocking rules could cost non-compliant providers thousands of dollars, directly penalizing hospitals under PIP and affecting the eligibility status of physicians and ACOs under other CMS programs.

The research process will be difficult, Deputy National Coordinator for Health IT Steve Posnack acknowledged during an October press call.

“We have emphasized from the beginning that with any claim blocking information, it will always be a case-by-case analysis,” he said.

“Some of that will be somewhat disentangling if there are multiple actors involved: if there is a developer who is certified in health IT, if there is a healthcare provider involved – who is ultimately or jointly the cause of the information blocking? Who can be responsible?

“These are all the challenges that our colleagues at (the HHS Office of Inspector General) will be grappling with first,” he explained, adding that ONC hopes fact sheets, FAQs and other types of information resources it will make available help clarify where accountability is required.

MGMA is concerned about physician practice costs and the administrative burden – including requirements around API connectivity – that interoperability rules have imposed since they were initially established.

ON THE RECORD

“Given the difficulties practices are currently experiencing in their ability to avoid a negative adjustment due to the well-documented issues with MIPS, and the ever-changing nature of the program, this automatic adjustment is unnecessarily punitive and would reduce the available reduce financial resources. practices,” MGMA said in a letter to ONC.

“Medicare reimbursement is already not keeping pace with inflation and costs, and practices face a 3.4% reduction in the conversion factor by 2024. Without significant change, this additional financial penalty could deter groups from participating to Medicare, while exacerbating the problems medical groups face. report under MIPS.”

Andrea Fox is editor-in-chief of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.