HITAC Suggests Removing Price Transparency Requirements from Information Blocking Rule

Samara Rosenfeld
MAY 23, 2019
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With the public comment period for the proposed interoperability rules slated to end on June 3, a subcommittee of the Health Information Task Advisory Committee (HITAC) suggested this week that the Office for the National Coordinator of Health Information Technology (ONC) remove price transparency requirements from its plan.
 
Tying the information blocking proposal too tightly with price transparency could have the unintended consequence of slowing down the finalization of the current rule, members noted.

ONC will review all recommendations to the proposed rule before releasing the final version.

The proposed information blocking rule is designed to increase innovation and competition by giving patients and their providers secure access to health information and new tools. The rule focuses on the patient’s ability to access their health information through a provision mandating that patients be able to electronically access their health information at no cost. The rule implements the information blocking provisions of the 21st Century Cures Act.
 
Information blocking is a practice by a provider, developer, health information exchange or health information network that is likely to interfere with, prevent or discourage the access, exchange or use of electronic health information.
 
The subcommittee responsible for this week’s recommendation, the Information Blocking Task Force (IBTF), recommended that ONC initiate a task force charged for producing recommendations for future rulemaking to address improving price transparency across healthcare.
 
The new task force should consider the following, according to IBTF
  • How price information can be made readily accessible and available to all stakeholders to inform care decisions
  • The coding for prices can be published by using the rate cards between the providers and payers
  • To get to price transparency, patients need to know the contract negotiated rates
  • How those involved in financial transactions to support healthcare delivery should provide the real prices
IBTF recommended that ONC use terminology to distinguish between pure cost or expense recovery with no provision for margin or profit where this is intended. And ONC should use terms such as “cost-based pricing” where margin or profit is allowed and “market-based pricing” where no restrictions on pricing are necessary.
 
The task force’s recommendations are intended to ensure that ONC’s information blocking rule is as clear and specific as possible.
 
The committee also made suggestions about parties affected by the information blocking provision and exceptions.
 
The task force suggested updating the preamble to better detail the real-work organizational types who would and wouldn’t fall into the various categories of actors. For example, IBTF believes that retail pharmacies who curate patient information relating to prescriptions, medications, clinical histories and payments should be considered providers through inclusion as a subpart of all pharmacies. The information is considered electronic health information and should not be blocked.
 
It’s essential to specifically identify that an entity should not share electronic health information when a patient has stated their information should not be shared.
 
The IBTF is committed to providing recommendations related to information blocking and maintenance of certification requirements.
 
The team also recommended that definition of health information exchange be changed to “any entity performing the access, exchange, transmittal, processing, handling or other such use of electronic health information (EHI) who is not considered a provider, health information network or health IT developer.”
 
The task force suggested clarifying that the developer of health IT is a developer because they create IT designed to perform the access, exchange or use of EHI whether or not the IT is certified.
 
There are seven exceptions to information blocking:
  1. Preventing harm
  2. Promoting the privacy of electronic health information
  3. Promoting the security of electronic health information
  4. Recovering costs reasonably incurred
  5. Responding to requests that are infeasible
  6. Licensing of interoperability elements on reasonable and non-discriminatory terms
  7. Maintaining and improving health IT performance
The Centers for Medicare and Medicaid proposed interoperability rule supports the use of technology to support the seamless flow of health information. The proposal says that it would benefit patients and caregivers to know if clinicians or hospitals have submitted a “no” response to statements regarding the prevention of information blocking.

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