The Office of the National Coordinator for Health Information Technology’s (ONC) proposed rules under the 21st Century Cures Ac, aimed at establishing disincentives for information blocking by healthcare providers. The rules have elicited varied responses from different electronic health record (EHR) groups. The rules primarily target providers participating in Centers for Medicare & Medicaid Services (CMS) programs, and are seen as a positive step in addressing information blocking practices that prevent the accessibility and sharing of electronic health information.
The American College of Radiology (ACR) supports the focus on providers engaged in CMS programs, viewing it as an appropriate mechanism for provider disincentives. The Electronic Health Record Association (EHRA) has expressed concerns, as while they acknowledge that providers engaged in the Merit-Based Incentive Payment System and Promoting Interoperability Program generally adhere to interoperability standards, the organization pointed out that providers exempt from these programs, like small practices with PI exemptions and ambulatory surgical centers, are less likely to have access to interoperable technology. This disparity raises challenges in meeting exchange requirements and suggests that distinct disincentives tailored to each provider category may be necessary. EHRA also argues that the proposed rule may not sufficiently motivate those hesitant to embrace information sharing, and suggests that ONC analyze information blocking complaints to determine the scope of proposed disincentives. EHRA further recommends that evidence related to system configuration and usage should be directed to the healthcare organization responsible for those settings.
The Health Information Management Systems Society (HIMSS) proposes a tiered approach to the disincentives. They suggest starting with a negative payment adjustment for the first offense, followed by education and resources on compliance. This is an alternative to immediate posting on the information blocking website. HIMSS acknowledges the perception that the costs of succeeding in the MIPS program might outweigh the incentive payments, and raises concerns about the redundancy of financial disincentives with existing MIPS requirements.The American Hospital Association (AHA) has criticized the proposed disincentives as excessive, warning that they could threaten the financial stability of economically challenged hospitals. The AHA’s members estimate that the penalties could be substantially higher than those suggested in the rule. The Medical Group Management Association (MGMA) warns that the proposed rules could exacerbate the administrative burden and financial strain on medical groups, affecting the delivery of Medicare and value-based care.
Other HIMSS members believe that the penalties for smaller practices are not remarkable enough to change information blocking behavior. ACR suggests leveraging enforcement discretion to provide warnings and compliance support for first-time violations, arguing that individual physicians rarely influence data-sharing policies and should not be primary targets for investigations and disincentives.The proposed exceptions to information blocking require extensive training, and each referral investigated will challenge the Office of Inspector General (OIG) to determine accountability among developers and providers of certified health IT. This complexity shows a clear need for accurate guidance and support for healthcare organizations navigating these new rules.
