CMS-based disincentives jeopardize info blocking participation, says MGMA

The Medical Group Management Association this week asked for greater transparency from the Office of the National Coordinator for Health IT in its proposed information blocking rules – and outlined several key recommendations to ease the burden for healthcare providers.

WHY IT MATTERS

“More clarity is needed about how the program operates, the applicability of exceptions and how it intersects with state laws,” MGMA said in its letter Tuesday.

Several organizations have been asking ONC to coordinate with other federal agencies to ensure a more cohesive patient information-sharing strategy. They have expressed the need healthcare providers have for technical assistance to protect privacy and security while they ensure interoperability.

“While we recognize the need for ONC and [Centers for Medicare & Medicaid Services] to establish appropriate disincentives for providers who commit information blocking under the 21st Century Cures Act, we harbor significant concerns with the proposed rule and its impact on medical groups,” the MGMA said.

Instead, the medical group practices membership organization proposes a corrective action process that would provide a remedy to allegations of information blocking without the threat of financial penalties that dissuade providers from Medicare participation.

“Properly allowing providers to correct offending conduct by using education and guidance would best facilitate information sharing,” the organization said.

MGMA also urged what it called a straightforward appeals process that ensures due process considerations to address a situation where they are wrongly accused of an information blocking situation “without suffering considerable financial harm,” and asked ONC to zero out the promoting interoperability category under the Merit-based Incentive Payment System.

Promoting Interoperability Performance is 25% of MIPS’ annual scoring, and each information blocking determination would affect an eligible clinician’s meaningful EHR user status for a single reporting period. 

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

That’s of little consolation to smaller providers, according to MGMA.

“The substantial administrative burden and difficulties medical groups face under the MIPS program will be exacerbated should the agencies move forward with this penalty,” the organizations said.

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

“Significant” administrative and financial barriers go against the agencies’ intentions to promote VBC and “undermines providers’ ability to succeed in MSSP,” MGMA said.

THE LARGER TREND

The proposed information blocking rules could cost noncompliant providers thousands, penalizing hospitals directly under PIP and affecting the eligibility status of clinicians and ACOs under other CMS programs. 

The investigation process will be difficult, Deputy National Coordinator for Health IT Steve Posnack acknowledged on a press call in October.

“We’ve emphasized from the beginning that with every single information blocking claim, it’s always going to be a case-by-case analysis,” he said. 

“Some of that is going to be kind of disentangling if there are multiple actors involved: If there’s a developer certified health IT involved, if there’s a healthcare provider involved – who ultimately or jointly caused the information blocking to take place? Who might be accountable?

“All of those are the challenges that our colleagues at [the HHS Office of Inspector General] will wrestle with first,” he explained, adding that ONC hopes fact sheets, FAQs and other types of informational resources it will make available will help to clarify where accountability should be.

MGMA has been concerned about physician practice costs and the administrative burden – including requirements around API connectivity – that interoperability regulations have posed since they were initially drafted.

ON THE RECORD

“Given the difficulty practices are currently seeing 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 diminish the financial resources available to practices,” MGMA said in its letter to ONC.

“Medicare reimbursement is already not keeping up with inflation and costs, and practices face a 3.4% cut to the conversion factor in 2024. Without significant change, this added financial penalty may dissuade groups from participating in Medicare, while amplifying the difficulties medical groups face reporting under MIPS.”

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