Home Health & Hospice Week

Are you a prime target for the new disincentives?

Context: Last month, the Centers for Medicare & Medicaid Services published a proposed rule in the Federal Register that builds on previous information blocking policies from both the HHS Office of the National Coordinator for Health Information Technology (ONC) and the HHS Office of Inspector General. Implementing Cures Act provisions,

HHS proposes to deter Medicare providers from information blocking by decreasing their pay, cutting their scores, or taking away their eligibility to participate, depending on the program they’re in.

“HHS is committed to developing and implementing policies that discourage information blocking to help people and the health providers they allow to have access to their electronic health information,” explains HHS Secretary Xavier Becerra in a release. “We are confident the disincentives included in the proposed rule, if finalized, will further increase the appropriate sharing of electronic health information and establish a framework for potential additional disincentives in the future.”

CMS’ proposed rule is comprehensive in nature and affects the Medicare programs aimed at physicians (Merit- Based Incentive Payment System) and hospitals (program integrity programs for meaningful EHR users).

Know These 4 Points On Investigations

But the rule can impact home health and hospice agencies too. It affects providers in the Medicare Shared Savings Program (MSSP) operating as an Accountable Care Organization (ACO), ACO participant, ACO supplier or provider.

“If determined by OIG to have committed information blocking,” a provider “would be barred from participating in the Shared Savings Program for at least 1 year. This may result in a health care provider being removed from an ACO or prevented from joining an ACO; and in the instance where a health care provider is an ACO, this would prevent the ACO’s participation in the Shared Savings Program,” the rule explains.

And HHS is using the CMP final rule (see box, this page) as a guideline for enforcement. Additionally, “OIG has discretion to choose which information blocking complaints to investigate,” the proposed rule says. “To maximize efficient use of resources, OIG generally focuses on selecting cases for investigation that are consistent with its enforcement priorities and intends to apply that rationale to its approach for selecting information blocking complaints for investigation,” the rule notes.

OIG will prioritize enforcement for information blocking based on these four criteria, according to the rule:

1. Incidents that resulted in or will potentially cause patient harm;

2. Incidents that interfere with a provider’s ability to care for patients;

3. Incidents that occurred over a long duration; and