Not so meaningful for some
Critical-access hospitals seek more clarity from feds
As healthcare providers digest HHS’ “meaningful use” regulations, the rural health community expressed concern last week that the definition lacks clarity for critical-access hospitals. Meanwhile, a coalition of rural and health information technology leaders offered recommendations to help rural providers manage perhaps an even greater problem: health IT workforce challenges.
Just a day after HHS announced its two regulations—which totaled nearly 700 pages combined—Louis Wenzlow, chief information officer at the Rural Wisconsin Health Cooperative, addressed the issue of meaningful use in his blog. In the entry, he writes that the proposed rule for the electronic healthrecord incentive program under the American Recovery and Reinvestment Act of 2009, also known as the stimulus law, excludes critical-access hospitals from Medicaid incentives.
“Numerous studies have indicated that CAHs have significantly lower EHR adoption rates than general hospitals, as well as great barriers to EHR implementation, including lack of capital, minimal HIT staffing levels, and reduced EHR system” return on investment, Wenzlow writes. “CAHs with high Medicaid utilization rates are likely to face even greater challenges than other CAHs, let alone general hospitals.”
The reason that the CMS excluded criticalaccess hospitals, Wenzlow explains, is because the stimulus law states that eligible Medicaid providers include children’s hospitals and acutecare hospitals that have at least 10% Medicaid volume. According to Wenzlow, critical-access hospitals have always considered themselves to be acute-care facilities—even though they are not classified as such by the CMS—as their inpatient services are for acute care, although limited to 25 beds.
Brock Slabach, senior vice president of member services for the National Rural Health Association in Kansas City, Mo., says critical-access hospitals are usually “financially on edge,” so this regulation could place them in an even more precarious position.
“If you take away tools for them to use resources to implement what is now becoming a national priority—on the digital highway— then you could have a whole subgroup of hospitals that are left behind in their adoption,” Slabach says. At the same time, the definition of “EHR-eligible expense” still lacks clarity for crit- ical-access hospitals, which will receive Medicare incentives based on their costs for purchasing EHR technology.
“CAHs have been waiting for a detailed definition of what qualifies as an eligible expense in order to make strategic EHR implementation decisions,” Wenzlow writes in his blog. “While the CMS and ONC rules provide some clarification, many ambiguities remain,” he writes, referring to the Office of the National Coordinator for Health Information Technology.
Even so, uncertainty about the rules should not hinder rural healthcare providers from advancing their own health IT initiatives, says Terry Hill, executive director of the Rural Health Resource Center in Duluth, Minn.
“To me, these are two wrong things to do: Rush headfirst and go out and do it and act too quickly without thinking,” or “to just sit there and not work on these issues,” Hill says of how rural providers should not approach health IT implementation. Instead, they should focus on things that they want to accomplish.
“Those things don’t require the ONC to make their final decision,” Hill says, adding that what he hears a lot is that many rural hospitals have some things in place but are not moving forward to advance their IT programs because they are overwhelmed with the amount of requirements and changes. “They don’t need more information,” Hill says, “They need to know the one or two things to move forward with this to help them work out some road maps and readiness assessments, and where they are in terms of their meaningful use.”
One serious problem that could be impeding progress is the lack of qualified professionals who understand not just information technol- ogy, but health information technology—and who are available to work in rural areas.
“IT people in general will be the hardest to find of all professions in the country,” Hill says. “Then you look at the folks doing HIT—they’re in dramatically short supply,” he adds. “We’re going to have a very compelling shortage.”
Addressing rural health IT workforce challenges was the focus of a summit held in Washington last September in conjunction with National Health IT Week. The summit was coordinated by the Rural Health Resource Center for the National Rural HIT Coalition, which is a network of rural and health IT leaders from regional, state, national and federal organizations who work together to advance health IT.
Since then, participants have developed recommendations for healthcare providers that center on data development, policy and workforce resources. The last category suggests that providers examine and document what health IT education programs now exist; identify current workforce retraining opportunities; promote interdisciplinary education; create certificates within community colleges and advanced degree programs that can meet rural needs; and ensure attention to multicultural, multilingual needs in EHRs.
Focusing on workforce issues has helped rural Thayer County Health Services in Hebron, Neb., adopt health IT successfully in the past few years. Thayer includes a 19bed critical-access hospital and a clinic in Hebron, and five satellite clinics throughout the county, located in southeastern Nebraska.
According to CEO Joyce Beck, rural hospitals should first establish a culture that is ready for change before they can have an effective health IT system. Beck says that a $1.6 million federal grant in September 2007 “catapulted us to where we are today,” which includes the use of EHRs, current work on the second generation of software at the clinics, and a staff that receives ongoing training and certification. And there’s another essential element that has helped Thayer become a high performer in health IT: a physician leader who embraces the concept.
“Most of the physicians I know have kind of taken a wait-and-see approach, where they’re waiting for someone to tell them or show them the way. I would do the opposite of that,” says Timothy Sullivan, a family practice physician at Thayer who also served on the grant committee.
“The key to that is: You have to work at it, study it, look at programs, go and talk to people who have been through it before,” Sullivan says. “Quite frankly, it’s amazing. The stuff will make your life better and your patients’ life better.”
Timothy Sullivan, a family practitioner with Thayer County Health Services in Nebraska, is an advocate of IT.