CMS-Based Disincentives Threaten Information Blocking – MGMA


The Medical Group Management Association within the first week of 2024 has gone on to ask for a greater level of transparency from the Office of the National Coordinator- ONC for Health IT in the proposed information blocking rules and has also gone on to outline numerous major recommendations in order to ease the burden for healthcare offerors.

As per MGMA, more clarity is indeed required on how the program functions, the applicability of the exception, as well as how it goes on to intersect with state laws.

It is well to be noted that many organizations have been asking for the ONC so as to coordinate with certain other federal agencies in order to make sure of a more cohesive information-sharing patient strategy. They have expressed the requirements healthcare providers have in case of technical assistance so as to protect privacy as well as security while they make sure of interoperability.

While they go on to recognize the need for ONC and Centers for Medicare & Medicaid Services to establish apt disincentives for providers who go on to commit information blocking under the 21st Century Cures Act, they harbor significant issues with the proposed rule and its effect on medical groups, said the MGMA.

Instead, the medical group practices that the membership organization proposes corrective action procedures that would offer a remedy to allegations of data blocking sans the threat of financial penalties that do not persuade providers from Medicare participation.

The organization said that properly allowing providers to correct the offending conduct by making use of education and guidance would best help the sharing of information.

MGMA also went on to urge what it referred to as a straightforward appeals process that makes sure of due process considerations in order to address a situation where they happen to be wrongly accused of a specific data blocking situation without suffering substantial financial harm and asked ONC to zero out the promoting interoperability category within the merit-based incentive payment system. Promoting Interoperability Performance happens to be 25% of MIPS’ yearly scoring, and each information blocking determination would go on to affect an eligible clinician’s meaningful EHR user status when it comes to a single reporting period.

CMS senior technical advisor Elizabeth Holland said there happens to be only one penalty per year even with more referrals for the same period at an info blocking exceptions webinar that was hosted by the U.S. Health and Human Services last November.

As per MGMA, this happens to be of little consolation to certain smaller providers.

The significant administrative burden as well as difficulties that the medical groups face under the MIPS program will get exacerbated if the agencies go ahead with this penalty, as per the organizations.

Similarly, the organization went on to say that moving forward with eliminating accountable care organizations as well as providers being a part of ACOs from the Medicare Shared Savings Program would go on to affect value-based care.

It is worth noting that significant administrative as well as financial barriers go against the agencies’ intent to promote VBC and also undermine the providers’ ability to be successful in MSSP, said the MGMA.

The information blocking rules that are proposed could cost noncompliant providers thousands, penalizing hospitals directly under PIP and also affecting the eligibility status when it comes to clinicians and ACOs when it comes to other CMS programs.

In October last year, Steve Posnack, Deputy National Coordinator for Health IT, said that the investigation process was going to be difficult. As per him, they have emphasized from the very beginning that with every single information blocking claim, it is always going to be a case-by-case analysis.

Some of that will be kind of disentangling if there happen to be multiple actors involved, like if there is a developer-certified health IT involved, if there happens to be a healthcare provider involved, who ultimately or in partnership caused the information blocking to happen? Who might then be accountable?

Posnack further said that all of those happen to be challenges that their colleagues at the HHS Office of Inspector General are going to wrestle with first, adding that ONC hopes fact sheets, FAQs, as well as other kinds of informational resources it is going to make available will help to clarify where accountability ought to be.

MGMA has been pretty concerned when it comes to physician practice costs and the administrative burden such as the needs around API connectivity that interoperability regulations have gone on to pose since they were initially taken into the draft.

According to the MGMA’s letter to the ONC, given the difficulty practices are at present seeing in their capacity to avoid a negative adjustment because of the well-documented issues with MIPS and also the ever-changing nature of the program, this automatic shift happens to be unnecessarily punitive and would subside the financial resources that are available to practices.

It is worth noting that Medicare reimbursement is not keeping up with inflation and costs already, and practices go on to face a 3.4% slash to the conversion factor in 2024. Without the significant change, this has gone on to add financial penalties and may dissuade groups from being a part of Medicare, while amplifying the challenges medical groups go on to face reporting under MIPS.