AHA challenges CMS and ONC’s proposed disincentives under the 21st Century Cures Act, fearing they could severely jeopardize small and rural hospitals’ financial stability. The association highlights the apparent underestimation of penalties’ true financial toll and suggests existing enforcement mechanisms, rather than tying penalties to healthcare reimbursements. Criticism extends to the unclear Inspector General processes and concerns about disproportionate punishments. AHA’s call for transparency and refined calculations urges CMS and ONC to reassess the proposed disincentive structure. The complexity of compliance in information-blocking exceptions demands swift provider adaptation, posing significant challenges. MGMA and NAACOS echo AHA’s worries, seeking clarity and alterations to ease the burden on healthcare providers.
The American Hospital Association (AHA) has raised significant concerns regarding the proposed disincentives outlined by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) in response to information blocking under the 21st Century Cures Act. AHA’s comments, detailed in a letter, point out various areas where they believe the penalties could prove excessively burdensome, potentially jeopardizing the financial stability of numerous small and rural hospitals.
AHA’s primary contention revolves around the perceived underestimation by CMS and ONC of the actual financial repercussions resulting from a 75% decrease in yearly market basket updates for Inpatient Prospective Payment System hospitals and a one percentage point reduction in Critical Access Hospitals’ reimbursements. The association emphasizes that the proposed disincentive structure could significantly threaten economically fragile hospitals, including those in smaller or rural areas.
The estimated median disincentive amount of $394,353 (with a range of $30,406 to $2,430,766 across eligible hospitals) set by CMS and ONC is contested by AHA’s member hospitals. They assert that the real impact could be considerably higher, reaching up to three times the upper limit and an average impact nearly 10 times higher than the figures stated in the proposed rule.
Instead of linking penalties directly to healthcare program reimbursements, AHA suggests utilizing existing practices, such as involving the Office of Civil Rights in the enforcement of HIPAA violations, which already has specific references to information sharing.
Additionally, AHA criticizes the perceived arbitrariness and lack of clarity in the proposed Office of the Inspector General processes responsible for determining information-blocking occurrences. The organization raises concerns about the fairness and consistency of the framework proposed, suggesting that relying on variable aspects of provider payment for disincentives could result in disproportionate punishments for similar offenses, depending on the timing and referral process to CMS.
Moreover, AHA highlights the frequent updates in the proposed rules, marking this as the fourth update since 2019 if finalized, signaling a continuous evolution and complexity in compliance requirements.
The broader trend surrounding information-blocking exceptions necessitates heightened attention from healthcare providers. Compliance requires navigating intricate details swiftly to avoid penalties. For instance, experts emphasize the need for a shift in provider behavior to comply with information-blocking rules, which differ significantly from the disclosure permissions under HIPAA.
Other healthcare organizations, such as the Medical Group Management Association (MGMA) and the National Association of ACOs (NAACOS), have also sought clarity from ONC and recommended alterations to mitigate the burden of proposed disincentives on healthcare providers. MGMA proposed a corrective action process to address information-blocking allegations without imposing severe financial penalties that might dissuade Medicare participation, while NAACOS sought changes to the rule affecting participation in the Medicare Shared Savings Program based on compliance status.
AHA’s critique of the proposed information-blocking disincentives urges CMS and ONC to reconsider their approach. The association’s insistence on transparent calculations and the use of existing enforcement mechanisms reflects a plea for fairness and viability, particularly for smaller healthcare institutions. The evolving landscape of compliance and the intricacies of information sharing pose significant challenges for providers. Joined by MGMA and NAACOS, AHA’s concerns underscore the broader industry worries regarding the potential ramifications of these disincentives. Addressing these issues and refining the proposed structure is imperative to ensure equitable penalties and sustainable healthcare practices.
