Small hos­pi­tals on the radar

Modern Healthcare - - SPECIAL REPORT - —Joseph Conn

If 2011 was the year the fed­eral government im­ple­mented its pro­grams to pro­mote the use of elec­tronic health-record sys­tems un­der the Amer­i­can Re­cov­ery and Rein­vest­ment Act, and 2012 was the year those plans were ex­e­cuted, 2013 is the year the feds will need to think small.

The fed­eral government has tar­geted more than 1,700 crit­i­cal-ac­cess hos­pi­tals or small and ru­ral hos­pi­tals for spe­cial as­sis­tance in meet­ing health IT goals, says Mat Ken­dall, di­rec­tor of the Of­fice of Provider Adop­tion Sup­port at HHS’ Of­fice of the Na­tional Co­or­di­na­tor for Health In­for­ma­tion Tech­nol­ogy. The 1,329 crit­i­cal-ac­cess hos­pi­tals are de­fined as hav­ing 25 or fewer beds, while “the vast ma­jor­ity” of the re­main­ing nearly 400 hos­pi­tals in the feds’ tar­get pop­u­la­tion have fewer than 50 beds, Ken­dall says.

By the end of Novem­ber, 1,164 of them had be­gun work­ing with a fed­er­ally sup­ported health in­for­ma­tion tech­nol­ogy re­gional ex­ten­sion cen­ter, or REC, and nearly 1,200 were ex­pected to have an EHR in op­er­a­tion by the end of 2012.

Of those, 19% achieved mean­ing­ful-use tar­gets un­der the Medi­care EHR in­cen­tive pay­ment pro­gram and had been paid, Ken­dall says.

“It’s a chal­lenge” with small hos­pi­tals, Ken­dall says. “There are huge needs.”

In con­trast, nearly half (48%) of all el­i­gi­ble hos­pi­tals not among the crit­i­cal-ac­cess hos­pi­tals have be­come mean­ing­ful users un­der Medi­care and re­ceived pay­ment, ac­cord­ing to CMS data through Novem­ber.

In its fo­cus on small and ru­ral hos­pi­tals, the ONC has or­ga­nized what Ken­dall calls “com­mu­ni­ties of prac­tice,” bring­ing to­gether ex­perts from the RECs and else­where to reach con­sen­sus on and dis­sem­i­nate best prac­tices for small hos­pi­tals to achieve mean­ing­ful use. Through th­ese ef­forts, myr­iad work­ing groups are look­ing at ways to over­come com­mon chal­lenges smaller hos­pi­tals are fac­ing, such as en­gag­ing hospi­tal lead­er­ship, find­ing a ca­pa­ble IT work­force, ac­cess­ing cap­i­tal and broad­band con­nec­tiv­ity and work­ing with ven­dors, Ken­dall says.

The RECs “sup­ply some level of sup­port, but it’s not a panacea,” says Keith Ryan, man­ag­ing prin­ci­pal with Cor­ner­stone Ad­vi­sors Group, a health IT con­sul­tancy that has worked with in­di­vid­ual fa­cil­i­ties and con­sor­tiums of small hos­pi­tals. The re­gional cen­ters do well “ed­u­cat­ing the ex­ec­u­tive level of th­ese or­ga­ni­za­tions to the enor­mity of the chal­lenges,” Ryan says, but over­all, “I don’t have a whole lot of faith in throw­ing money at the RECs in help­ing crit­i­cal-ac­cess hos­pi­tals.”

Some of the health IT ven­dors—Ryan men­tioned Epic Sys­tems and Meditech specif­i­cally— are start­ing to ad­dress the needs of smaller hos­pi­tals by al­low­ing their pri­mary cus­tomers, larger hos­pi­tals, to re­sell li­censes to their smaller neigh­bors. Ryan sees that as a more re­li­able strat­egy to ex­tend IT to smaller hos­pi­tals.

Fed­eral IT pol­i­cy­mak­ers will face a dif­fer­ent chal­lenge in 2013 main­tain­ing the mo­men­tum to­ward mean­ing­ful use among of­fice-based med­i­cal prac­ti­tion­ers. Through Novem­ber, 170,543 physi­cians and other “el­i­gi­ble pro­fes­sion­als” had been paid un­der ei­ther the Medi­care or Med­i­caid EHR in­cen­tive pro­grams. That’s only about a third of the 531,600 providers that, ac­cord­ing to government es­ti­mates, could qual­ify for pay­ments. As with hos­pi­tals, the smaller and more ru­ral of­fice-based physi­cians are lag­ging be­hind in IT adop­tion com­pared with their larger and more ur­ban coun­ter­parts, ac­cord­ing to re­search.

In 2013, to­tal el­i­gi­ble-pro­fes­sional pay­ments un­der the Medi­care por­tion of the EHR in­cen­tive pro­gram will drop from $44,000 to $39,000 for first-time qual­i­fiers. Re­duced pay­ments could act as a brake on par­tic­i­pa­tion, but the stim­u­lus law also calls for a 1% cut in Medi­care pay­ments to el­i­gi­ble pro­fes­sion­als who don’t meet mean­ing­ful use in 2013.

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