Various healthcare organizations, including EHRA, ACR, HIMSS, and AHA, have offered diverse insights on the proposed federal rule establishing disincentives for information blocking. The feedback touches on concerns about the financial impact on hospitals, redundancy with existing penalties, and the need for tailored disincentives for different provider categories. EHRA emphasizes the potential ineffectiveness of proposed disincentives, while HIMSS suggests a tiered approach. AHA raises alarms about the destabilizing effect on economically challenged hospitals. The nuanced feedback calls for careful consideration in finalizing the rule to ensure comprehensive compliance and effective support for interoperable health information exchange.
As the healthcare industry navigates proposed federal rules on information-blocking disincentives, key organizations, including EHRA, ACR, HIMSS, and AHA, are voicing their opinions. The focus is on providers participating in CMS programs, with concerns raised about the potential financial impact on hospitals, redundancy in penalties, and the effectiveness of proposed measures for smaller practices. EHRA questions the motivation for behavioral change, while HIMSS suggests a tiered approach to disincentives. AHA highlights the threat to economically challenged hospitals. This diverse feedback underscores the complexities involved and emphasizes the importance of tailored approaches for different provider categories.
The majority of disincentives target providers participating in Centers for Medicare & Medicaid Services (CMS) programs, a mechanism supported by organizations like the American College of Radiology. The EHRA emphasized that providers engaged in existing CMS programs are likely to adhere to interoperability standards. However, those exempt or ineligible for these programs, such as small practices and ambulatory surgical centers, may face challenges in meeting exchange requirements due to limited access to interoperable technology.
EHRA argued that incorporating information-blocking disincentives into other CMS Innovation programs could impact smaller practices, urging tailored disincentives for various provider categories. EHRA further contended that the proposed rule might not effectively convince organizations to embrace information sharing, especially if they perceive limited motivation for behavioral change based on proposed financial impacts.
The EHRA raised a crucial point, suggesting that the proposed rule’s focus on Certified EHR Technology (CEHRT) users contradicts the ONC’s previous emphasis on all providers engaging in information sharing, irrespective of their CEHRT usage. The organization called for an analysis of information blocking complaints received to date to ensure that disincentives cover a broad spectrum of providers.
EHRA also noted that investigations into its developer members by the U.S. Health and Human Services may lack context, as developers may not always configure or monitor the usage of certified health IT features within an organization. The organization recommended directing evidence related to system configuration and usage to the healthcare organization responsible for those settings.
HIMSS, in its comment letter, recommended a tiered approach for disincentives, suggesting negative payment adjustments for the first offense and subsequent education and resources to facilitate compliance. This approach allows providers acting in good faith to rectify issues without losing incentive payments.
The American Hospital Association voiced concerns over the potential financial impact of ONC’s disincentives, stating that they could threaten the stability of economically challenged hospitals. AHA criticized the proposed formula, estimating penalties that could be three times higher than the upper-level range stated in the rule, with an average impact nearly ten times higher than the median quote.
HIMSS acknowledged a widespread perception that succeeding in the Merit-Based Incentive Payment System (MIPS) program costs more than the incentive payments provide. The organization expressed concern about the redundancy of financial disincentives with existing penalties associated with failing to meet current requirements for Promoting Interoperability (PI) and MIPS.
The Medical Group Management Association (MGMA) added its voice, asserting that ONC’s proposed rules would impose an undue financial burden, affecting the delivery of Medicare and value-based care. MGMA emphasized that the administrative burden and challenges faced under the MIPS program would worsen if the proposed penalties were implemented.
Despite concerns about smaller practices, both EHRA and HIMSS noted that penalties might not be significant enough to deter information-blocking behavior, particularly if there is a business case for such actions. In contrast, ACR proposed leveraging enforcement discretion to “hold harmless” providers for first-time violations, emphasizing the need for warnings and compliance support.
ACR argued that individual physicians, who rarely influence data-sharing policies, should not be a priority target for information-blocking investigations and disincentives. The organization stressed that proposed exceptions to information blocking in ONC’s rule would require significant training, and investigating each information-blocking referral would necessitate disentangling accountability between developers and providers of certified health IT.
The multifaceted feedback from healthcare organizations on proposed information-blocking disincentives showcases the intricate landscape of challenges and concerns within the industry. As EHRA questions the persuasiveness of financial impacts, HIMSS proposes a nuanced tiered approach. AHA flags potential threats to hospital stability, emphasizing the need for careful consideration. The varied perspectives underscore the intricate nature of achieving interoperable health information exchange. In finalizing the rule, it is imperative to address these concerns comprehensively, ensuring a balanced and effective framework that encourages widespread compliance across diverse provider categories.
