ONC information blocking negative incentives is 'excessive,' says AHA

The American Hospital Association had four comments for the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology on the proposed federal rule to establish disincentives for providers found to have blocked information on under the 21st Century Cures Act.

WHY IT MATTERS
According to AHA's comments in Tuesday's letter“it appears that CMS and ONC have assessed the actual financial impact of a 75% decrease in annual market basket updates for (Intramural future payment system) hospitals and a one percentage point reduction in reimbursement” for critical access hospitals.

As the letter continues to outline the organization's comments on the draft, it begins by explaining its concerns about the potential financial impact by starting with the landmark 2016 health care legislation itself.

According to AHA, “the CURES Act does not force the Department of Health and Human Services to designate CMS as the appropriate agency and, by extension, Medicare reimbursements, as a means of monetary disincentives.”

The organization said that according to its calculations, the disincentive structure outlined in the proposed rule is so excessive, “that it could jeopardize the financial viability of economically vulnerable hospitals, including many small and rural hospitals,” according to AHA.

Member hospitals tested the estimated median disincentive amount of $394,353 and the range of $30,406 to $2,430,766 among eligible hospitals, as determined by CMS and ONC, and said its impact would be much greater.

“Using the formula outlined in this scenario, several AHA members estimated what their own penalties could be and concluded that the impact could be more than three times greater than the highest level stated in the range published in the rule, and an average impact nearly 10 times higher than the median reported in the rule,” AHA said.

Rather than penalize health care program reimbursements, the organization recommends using a table that has already been established: “existing practices, such as referring enforcement of HIPAA violations to the Office of Civil Rights.” AHA noted, “there are already specific references to HIPAA.”

In addition, AHA said the proposed rules for the Office of Inspector General's processes that would determine whether information blocking has occurred “appear arbitrary and capricious. It is “unclear, including the appeals process,” AHA said in its comments.

The agency basing the disincentives on variable aspects of payment to providers would create an “unfair and confusing framework” in which disproportionate penalties can be imposed for the same violation, depending on the year of the violation and how long it takes to get to the violation is referred to. CMS.”

Finally, AHA noted that the rules, if finalized, would be the fourth update to the program since 2019.

THE BIG TREND
As with many regulations, the devil is in the details. Exceptions to blocking information require special attention from providers. Healthcare IT news attended government and industry webinars in which policy and data privacy experts reviewed a significant level of detail that providers must quickly navigate to avoid fines.

“For those of us accustomed to living under HIPAA, which allowed but did not require certain disclosures, the information blocking rules will now in most cases require certain disclosures to decline to disclose information under the privacy exception,” says Jennifer Hennessy. , data privacy attorney at Foley & Lardner, explained during a November webinar hosted by the American Telemedicine Association.

The Medical Group Management Association and the National Association of ACOs are also asking ONC for clarity and have made recommendations to ease the proposed daunting burden on healthcare providers.

MGMA proposed 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, while NAACOS requested changes to the rule prohibiting participation in the Medicare Shared Savings Program if the ACO or its physicians are found not to be in compliance.

“Properly allowing providers to correct abusive behavior through the use of education and guidance would best facilitate information sharing,” MGMA said in its letter, also sent Tuesday.

ON THE RECORD
“The AHA urges CMS and ONC not to finalize this daunting structure,” the American Hospital Association said in its letter on the proposed rule. “Should this proceed, we urge agencies to verify their calculations and be transparent in publishing the specific formula used so that stakeholders can better understand the discrepancy between their impact figures and those of the agencies.”