The U.S. Department of Health and Human Services (HHS) has finalized a rule establishing disincentives for certain health care providers determined to have engaged in information blocking. Effective as of July 31, 2024, the rule implements provisions of the 21st Century Cures Act aimed at promoting health care data interoperability and discouraging practices that impede the exchange of electronic health information (EHI). 

According to HHS Secretary Xavier Becerra, the rule is “designed to ensure we always have access to our own health information and that our care teams have the benefit of this information to guide their decisions.” He further stated that it is when health information can be “appropriately accessed and exchanged [that] care is more coordinated and efficient, allowing the health care system to better serve patients.” 

MEDICARE PROMOTING INTEROPERABILITY PROGRAM 

According to a Fact Sheet released by HHS, the following apply under the Medicare Promoting Interoperability Program: 

• An eligible hospital or critical access hospital (CAH) that commits information blocking will not be a ‘meaningful electronic health record (EHR) user’ in an applicable EHR reporting period; 
• The impact on eligible hospitals will be a reduction of three quarters of the annual market basket update; and,
• For CAHs, payment will be reduced to 100 percent of reasonable costs instead of 101 percent. 

QUALITY PAYMENT PROGRAM 

Under the Promoting Interoperability performance category of the Merit-based Incentive Payment System (MIPS), the following applies according to the above-mentioned Fact Sheet: 

• A MIPS eligible clinician that commits information blocking will not be a meaningful user of certified EHR technology in a performance period and will therefore receive a zero score in the Promoting Interoperability performance category of MIPS, if required to report on that category; and, 
• If a MIPS eligible clinician participating in group reporting is found to have committed information blocking, only the individual will be subject to a disincentive, not the group. 

MEDICARE SHARED SAVINGS PROGRAM 

According to the same Fact Sheet, the following applies under the Medicare Shared Savings Program: 

• An Accountable Care Organization (ACO), ACO participant, or ACO provider or supplier may be deemed ineligible to participate in the program for at least one year. 
• This may result in a health care provider being removed from an ACO or prevented from joining an ACO. 
• In the instance where a health care provider is an ACO, this may prevent the ACO’s participation in the Shared Savings Program. 
• Restricting the ability of health care providers to participate in the Shared Savings Program for at least 1 year will result in these health care providers potentially not receiving revenue that they might otherwise have earned if they had participated in the Shared Savings Program. 

Instances of potential information blocking will be investigated by the HHS Office of Inspector General (OIG), and according to the rule, will “depend on the specific facts and circumstances presented in the allegation.”  

Categories: DATA ACCESS & INTEROPERABILITY, Uncategorized

Tags: 21st Century Cures Act, disincentives for information blocking, health data, healthcare data access, healthcare data interoperability, information blocking