The U.S. Department of Health & Human Services (HHS) has released a final rule intended to discourage healthcare providers from interfering with the access, exchange or use of electronic health information. The rule specifically focuses on establishing disincentives for healthcare providers who participate in federal programs and are found by the HHS Office of Inspector General (OIG) to have committed information blocking.
Over the last several years, the HHS has steadily bolstered patient access to and exchange of electronic health information. This crescendo led to OIG’s final rule in June 2023, which established penalties for information blocking actors other than healthcare providers, as identified in the Cures Act (i.e., electronic health records [EHR] developers and health information exchanges [HIEs]). This most recent rule complements the OIG’s 2023 action.
Key Provisions: What Rheumatologists Need to Know
In the rule, the HHS takes aim at providers who participate in at least one of three value-based payment programs and have been determined by the OIG to have engaged in information blocking. The three programs and the relevant provisions in the rule for each are:
- Merit-Based Incentive Payment System (MIPS)
- Eligible providers and groups who are Medicare Part B providers and are determined by OIG to have engaged in information blocking will be denied meaningful user status within MIPS during the period in which the information blocking occurred. The rule amends the MIPS definition of “meaningful user” to exclude an information blocker.
- An eligible provider or group subject to this disincentive will receive a Promoting Interoperability score of zero, which will greatly impact their overall MIPS score and any associated payment adjustments.
- Groups that are not information blockers will not be penalized for an individual clinician’s information blocking actions. However, they will be required to report MIPS data without contributions from the offending provider.
- Medicare Promoting Interoperability Program
- An eligible hospital or critical access hospital (CAH) will not be considered a meaningful EHR user in the applicable reporting period if OIG determines that the eligible hospital or CAH committed information blocking.
- An eligible hospital subject to this disincentive will not be able to earn the three quarters of the annual market basket increase associated with qualifying as a meaningful EHR user. This may lead to a reduction of 75% of the annual market basket increase for eligible hospitals and a decrease in payment to 100% (from 101%) of reasonable costs for CAHs.
- Accountable Care Organizations (ACO)
- Medicare providers that are an ACO, ACO participant, or ACO provider or supplier found by OIG to have committed information blocking may be ineligible to participate in the CMS Shared Savings Program for at least one year.
- This will result in loss of revenue from the Shared Savings Program.
Rule Compliance: What Do Rheumatologists Need to Do?
The rule becomes effective on Aug. 1, 2024. To comply with this rule, rheumatologists should review the American Medical Association’s educational materials on what constitutes information blocking and the steps providers should take to comply with information blocking regulations. Further, rheumatologists can submit an information blocking complaint to the ONC Information Blocking Portal or the OIG Hotline. They can also email the ACR’s advocacy team at [email protected] with any questions.
