We are finally arriving at a place in healthcare history where transparency and timely access to patient data are realizable. It has been well recognized that “behavior”, not technology is the primary barrier to surmount to accomplish this goal. Office of the National Coordinator for Health Information Technology (ONC) and the Office of Inspector General (OIG) have recently introduced disincentives to ramp up enforcement to ensure health IT developers and providers change their behavior and don’t restrict access to patient information without a valid reason. At the heart of this enforcement is a staggering penalty of up to $1 million per violation for developers and a percentage of Medicare reimbursement deducted for the providers (could be >$1 million) found guilty of information blocking. This hefty penalty emphasizes the importance of compliance with information sharing requirements, making compliance not the best choice but the only choice.

The Stakes Have Never Been Higher

$1 million per violation is more than just a number. For health IT developers, it represents a potential risk that could lead to severe financial consequences, reputational harm, and lasting business impacts. The ONC’s mandate emphasizes that health IT developers must enable their customers to provide appropriate access to electronic health information (EHI) and avoid obstructing or restricting the flow of patient data. Failure to do so will come at a significant cost, impacting a developer’s ability to grow, innovate, and serve their customers effectively.

Real-World Consequences: Fines are Being Issued

This isn’t just theoretical. Some have been hit with substantial penalties. Health IT developers and providers are already experiencing the consequences of information blocking violations. The Department of Health and Human Services (HHS) and the OIG recently finalized the Disincentive Program to penalize providers found guilty of information blocking. This program enforces serious repercussions that would affect Medicare and Medicaid reimbursements, signaling that the penalties are real and escalating. Additionally, ONC will publicly post a “wall of shame” containing information about healthcare providers found to have committed information blocking.

Programs for Enforcement and Penalties

The HHS Final Rule established the disincentives that will target the hospitals and provider practices within the Quality Payment Program as follows:

Hospitals - Promoting Interoperability Program

An eligible hospital will not be considered a meaningful EHR user for any reporting period in which OIG determines that the hospital has committed information blocking. If OIG refers a hospital, CMS will reduce its payment by 75% of the market basket update.
A Critical Access Hospital (CAH) will have its payment reduced from 101% to 100% of the reasonable costs it might have earned in a year.
- The proposed provider disincentives rule estimated a median disincentive amount of about $395,000 (ranging from $30,000 to $2,500,000 across eligible hospitals), assuming a 32% market basket increase.

Individual Providers and Groups - MIPS Program
- A MIPS-eligible clinician will not be considered a meaningful EHR user in a performance period if OIG determines that the clinician committed information blocking. Clinicians who are found to have committed information blocking will receive a score of zero in the Promoting Interoperability category of MIPS, which typically accounts for a quarter of the total composite score.
- Notably, CMS will not use a group score if even one eligible clinician in a group is found to be information blocking.
  - For MIPS-eligible clinicians, the proposed rule estimated an individual disincentive amount starting from $7,000 per eligible clinician. For groups of 2 or more clinicians, ONC estimated a group disincentive of up to $165,000 depending upon the level of information blocking infraction.

Expediting Compliance Efforts with MeldRx

Darena Solutions offers an efficient, reliable pathway to meet and maintain compliance for developers and providers facing compliance challenges. Our MeldRx application is specifically designed to facilitate information sharing and avoid penalties for information blocking. With MeldRx, organizations gain access to:

ONC Certified Modules: Our applications are fully certified to meet the latest ONC standards (HTI-1, FHIR, and USCDI), helping you fulfill regulatory requirements with confidence.
Publish and Maintain Service Base URLs: We provide up-to-date and fully accessible service base URLs that meet regulatory demands, ensuring seamless data exchange and accessibility.
Regulatory Updates: As regulations evolve, MeldRx keeps you current with timely updates, so your compliance framework remains robust and responsive to new guidelines.

By incorporating MeldRx, organizations can avoid the risks associated with non-compliance while optimizing their data-sharing capabilities for a transparent and efficient health IT environment. Darena Solutions handles the technology aspect, allowing you to demonstrate compliant information sharing practices.