Healthcare providers who engage in information blocking could face significant financial penalties if the proposed rules released this week by the U.S. Department of Health and Human Services are implemented.
WHY IT MATTERS
As required by the 21st Century Cures Act, the HHS Office of Inspector General has the authority to respond to complaints about information blocking and to determine whether health care organizations have “knowingly and unreasonably” interfered with access, exchange, or use of electronic health information (despite some specific exceptions).
HHS has already indicated this information blocking fines for the other actors subject to the rules: certified IT developers and health information exchanges/networks. These types of organizations are subject to a $1 million fine per violation, as determined by OIG.
These new rules describe potential ‘barriers’ that are being focused on healthcare providers – who can be punished in different ways, depending on the type of care they provide.
HHS is seeking public comment on the proposed rule published in the Federal Register on Wednesday, no later than January 2, 2024.
Under this rule, the Office of the National Coordinator for Health IT has developed three mechanisms intended to prevent providers from blocking information – all based on reimbursement programs from the Centers for Medicare and Medicaid Services.
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For hospitals, under Medicare’s Promoting Interoperability Program, an eligible or critical access hospital that the OIG has determined to engage in information blocking may be considered “not a significant user of electronic health records” in an applicable EHR reporting period, according to HHS . “The impact on eligible hospitals would be the loss of 75 percent of the annual market basket increase; for CAHs, payment would be reduced to 100 percent of reasonable costs instead of 101 percent.”
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For ambulatory care providers, under the Advancing Interoperability performance category of the merit-based pay system, an eligible clinician or blocker group would also be designated as not achieving meaningful use under the Advancing Interoperability performance category of MIPS – a score that typically representing a quarter of a physician’s or group’s total MIPS score in a year.
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And for health care providers who are part of an accountable care organization, an OIG information blocking determination could make them ineligible to participate in the Medicare Shared Savings Program for a period of at least one year. This could result in a provider being removed from an ACO or prevented from joining an ACO.
ON THE RECORD
“HHS is committed to developing and implementing policies that discourage information blocking to help people and the health care providers they give access to their electronic health information,” HHS Secretary Xavier Becerra said in a statement. “We are confident that the disincentives included in the proposed rule, if finalized, will further increase the appropriate exchange of electronic health information and create a framework for potential additional disincentives in the future.”
Mike Miliard is editor-in-chief of Healthcare IT News
Email the writer: mike.miliard@himssmedia.com
Healthcare IT News is a HIMSS publication.