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Some hospitals at risk for electronic record penalties

By Andrew M. Seaman

NEW YORK (Reuters) - Small and rural U.S. hospitals are most at risk of not satisfying certain federal requirements for using electronic health record systems, according to a new study.

Targeted grants might help the lagging hospitals get up to speed and avoid fines, researchers suggest.

"The area where we really see challenges is that there are certain types of hospitals that appear to be moving faster than others," Catherine DesRoches, the study's lead author from Mathematica Policy Research in Cambridge, Massachusetts, said.

"The further they fall behind, the more at risk they are for penalties," she added.

Under the 2009 Health Information Technology for Economic and Clinical Health act, hospitals and healthcare providers must be able to demonstrate by 2015 that their electronic health records (EHR) systems are capable of certain tasks that constitute "meaningful use."

The Centers for Medicare and Medicaid Services (CMS) oversees an incentive program to promote adoption of such systems in stages leading up to 2015.

Currently, to receive a payment, providers must meet 19 of 24 "meaningful use" objectives that include electronically tracking patients' medications and allergies, sending reminders, sharing lab test results and producing summaries of a patient's office visit.

More than 3,750 hospitals have received a total of $8.8 billion in "meaningful use" incentive payments as of July, according to the CMS website.

Providers that still don't meet the requirements in 2015 will start incurring penalties.

In June, DesRoches published a study that found only one in 10 doctors with EHRs met the basic requirements for the program by the end of 2012, despite the government's hefty financial incentives.

For the new study, DesRoches and researchers from the American Hospital Association analyzed Medicare data to see which types of hospitals were receiving incentive payments indicating progress toward the meaningful use goals.

Between 2011 and 2012, the researchers found, the percentage of hospitals nationwide receiving incentive payments more than doubled from about 17 percent to about 37 percent.

But considerable disparities among hospital types and regions have emerged, the researchers report in the journal Health Affairs.

Hospitals in the Northeast were most likely to receive incentive payments, compared to those in other parts of the country, with the West trailing. In 2012, 47 percent of Northeast hospitals got the payments, followed by 41 percent of hospitals in the South, 32 percent in the Midwest and just under 29 percent in the West.

Teaching hospitals were more likely to receive federal incentive payments than nonteaching hospitals, and for-profit hospitals more likely to receive the payments than not-for-profits.

Less than 30 percent of government-owned hospitals got the incentives in 2012.

In all categories, as the number of beds at facilities got smaller, the percentage of hospitals receiving payments dropped.

More than half of the hospitals with 200 or more beds received incentive payments, compared to just about 27 percent of hospitals with fewer than 100 beds.

"The program appears to be working. You are seeing this really nice increase in the number of hospitals getting paid for meaningful use, but it's not uniform," DesRoches said.

She and her colleagues express concern about small hospitals, including rural hospitals that are considered "critical access" facilities because they are often the only ones serving large remote areas.

Just 10 percent of critical-access hospitals received the incentives in 2012.

These smaller hospitals may have difficulty coming up with the financial resources to implement an EHR system meeting the requirements, they may have trouble attracting the proper support staff to manage the EHRs and they may also have trouble competing with larger clinics for the systems, the study authors point out.

There have been "infrastructure issues" when it comes to smaller and critical-access hospitals, according to Kimberly Lynch, director of the Regional Extension Center (REC) Programs at the Office of the National Coordinator for Health IT in Washington, DC.

But the REC programs, which provide on-the-ground assistance to providers trying to implement meaningful use, "is an invaluable resource to hospitals and providers who want to meet the meaningful use requirements," she added.

"Having the RECs there to assist them and provide education on those pieces… our clients just say that is invaluable to them," Lynch, who wasn't involved in the new study, told Reuters Health.

The Office of the National Coordinator for Health IT has paid special attention to critical-access hospitals, according to Leila Samy, the agency's Rural Health IT Coordinator.

"It is very hard and they are rising to the challenge, but exactly as Kim said that doesn't mean the work is ever done. We need to continue to focus on them and rally to get them what they want," Samy, who also wasn't involved in the new study, said.

SOURCE: http://bit.ly/1dLmFae Health Affairs, online August 2013.

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