AHA joins chorus against information blocking rules

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The American Hospital Association has joined voices urging the Centers for Medicare and Medicaid Services and the Office of the National Coordinator not to finalize a proposed rule on information blocking.

"First, the disincentive structure proposed in this rule is excessive, so much so that it may threaten the financial viability of economically fragile hospitals, including many small and rural hospitals," the AHA said in its January 2 letter to CMS Administrator Chiquita Brooks-LaSure and National Coordinator for Health Information Technology at the ONC, Mikey Tripathi.

"The AHA urges CMS and ONC not to finalize this disincentive structure. Should it move forward, we urge the agencies to verify their calculations and be transparent in publishing the specific formula used so that stakeholders can better understand the discrepancy between their impact numbers and those of the agencies," the letter from Ashley Thompson, senior vice president of Public Policy for the AHA.

WHY THIS MATTERS

Financial penalties for providers found to have blocked information sharing would reduce reimbursement under the Traditional Medicare program, the AHA said. 

"For hospitals and health systems paid under the inpatient prospective payment system (IPPS), CMS would reduce the market basket update by 75%. For critical access hospitals (CAHs), CMS would reduce reimbursement by 1 percentage point," the AHA said. "CMS and ONC underestimated the real financial impact of a 75% decrease in yearly market basket updates for IPPS hospitals and a 1 percentage point reduction in the reimbursement for CAHs, the organization said. In the proposed rule, CMS and ONC reference a hypothetical scenario of a proposed 3.2% market basket increase and a reduction of three-quarters of that percentage increase if the disincentive was applied."

Several AHA members estimated what their own penalties might be and found the impact could be more than three times the upper-level number quoted in the range published in the rule, Thompson said.

"For critical access hospitals, a 1% cut in payment would be very challenging. This is especially true as sequestration results in CAHs already receiving Traditional Medicare payments below costs, and payments from Medicare Advantage plans, which are rapidly expanding in rural areas, often pay below Traditional Medicare. Any additional cuts to these providers could be devastating for rural communities," the letter said.

The AHA recommends CMS and ONC reconsider applying disincentives through the market basket payment adjustment.

THE LARGER TREND

The AHA has close to 5,000 member hospitals and health systems and more than 270,000 affiliated physicians.

The AHA said it is concerned that the processes by which the Office of the Inspector General would determine if information blocking has occurred are unclear, including the appeals process.

Disincentives are based on variable aspects of provider payment, such as the value of the market basket adjustment and certain performance incentives in a given year.

"As a result, it would create an unfair and confusing framework in which disproportionate punishment could be levied for the same offense depending on the year of the offense and how long it takes for the violation to be referred to CMS," the AHA said.

The rule would, if finalized, be the program's fourth update since 2019.

"Such instability in program rules has created substantial burden and confusion for providers, detracting from one of the program's key goals: to use information technology to improve patient outcomes by easing access to electronic health information – a part of which is reducing burden," the AHA letter said.

The AHA also recommends that disincentives related to ACOs be introduced in a separate rule once those risks are better understood.

"We also strongly suggest developing any ACO-specific penalties in close consultation with those administering an ACO to ensure the agencies understand the impact of any proposed penalties," the AHA said.

NAACOS, the National Association of ACOs, submitted concerns in a letter to CMS and the ONC. MGMA and NAACOS have also asked CMS and the ONC for changes to the information blocking rules.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org