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Meaningful Use Push for Rural Hospitals is On

 |  By John Commins  
   October 03, 2012

Officials with the Office of the National Coordinator have issued an "all hands on deck" call to accelerate meaningful use certification for more than 1,000 small rural hospitals by the end of 2014.

ONC's Mat Kendall, director, Office of Provider Adoption Support, and Leila Samy, Rural Health IT Coordinator made the call in a blog post last week, and announced that ONC will provide up to $30 million in supplemental for Regional Extension Centers to make it happen.

"We need everyone rowing in sync," Kendall and Samy wrote, "including leadership and staff in every critical access and rural hospital, EHR vendors, hospital associations, and state offices of rural health in every state, Rural Health IT Network Development grantees, ONC grantees, and many more public and private, Federal and local partners."

The federal government is finally applying nautical metaphors to problems with meaningful use attestation that rural healthcare providers and advocates have complained about for months — namely that smaller rural hospitals have been given short shrift in the move to meaningful use.

Kendall and Samy enthusiastically note that more than 1,220 critical access hospitals and rural hospitals have enrolled with an REC for assistance with meaningful use attestation.

"This is great news because it provides data supporting the anecdotal evidence that Critical Access Hospitals and rural hospitals along with the clinicians working in these hospitals recognize the value of health IT and want to offer their communities healthcare services powered by the benefits of meaningfully using certified EHRs," they write.

No kidding!

Yet Kendall and Samy concede that other meaningful use data for rural hospitals is less rosy. 

In August the Centers for Medicare & Medicaid Services reported that while 1,333 hospitals—roughly 25% of all hospitals in the United States—had successfully attested to meaningful use and would receive incentive payments. However, only 186 of those certifications were for critical access hospitals, a number that represents about 15% of the nation's critical access hospitals.

The federal fiscal year started on Oct. 1. Even though hospitals have until Nov. 30 to achieve meaningful use certification for FY2012 and thus receive the first of four years of incentive payments, it looks like the vast majority of critical access hospitals won't make the cut.

Chantal Worzala, director of policy at the American Hospital Association, welcomes the notion that federal officials are putting money up to address the "digital divide" for rural hospitals.  

"Clearly the data show that rural hospitals are behind their urban counterparts," Worzala tells HealthLeaders Media. "Given that particularly critical access hospitals are by definition smaller and have fewer resources, we did from the very beginning worry that they could be left behind by this program."

"It is about money," she says. 

"They don't have the same resources as large academic medical centers or urban facilities, partly because of their size, but also because they have a smaller population.  They do struggle to be able to afford the workers needed to support EHR. That is not just technical staff, but clinical staff that can bridge the technical and clinical. Of course attracting people to an area that doesn't have all the urban amenities makes it a challenge as well."

Tehachapi (CA) Valley Healthcare District recently became one of those critical access hospitals to achieve meaningful use attestation. CEO Alan J. Burgess says going through the process made it clear that rural hospitals were an afterthought when the federal government devised the criteria.

"I don't think ONC really understands rural health. The rules clearly were written for large municipal hospitals with all the different services," he says. "The standards weren't very flexible in light of small and rural facilities. Sometimes you have to keep patients longer because there is no step-down available within 100 miles. Those are issues that I have to deal with every day that most big city hospitals don't have to deal with." 

Brock Slabach, senior vice president for the National Rural Health Association, says rural providers also have been slower to implement meaningful use because of continued uncertainty about what is actually covered under the reimbursement.

"With that uncertainty comes paralysis," he says. "If you have a $1.5 million project on the table and you don't know if only $1 million is available at the accelerated reimbursement or $1.4 million is eligible, obviously these small facilities that are already cash-strapped don't want to take a risk of having $400,000 disallowed from the higher reimbursement rates and so they are just not moving forward."

Slabach says he is heartened to see that ONC is plunking down another $30 million to help with meaningful use implementation.

"We will see how that plays out. I am not sure about the details and I'm not sure they are either," he says. "But if they have the resources those would be welcome to address the glaring problems that we are experiencing."

He cautions, however, that the Centers for Medicare & Medicaid Services is ultimately responsible for the meaningful use program, not ONC.

"Obviously we will need to work with CMS as a partner in this to make sure the right hand and the left hand know what is going on," Slabach says. "CMS has made some changes recently that we are encouraged by, for example allowing for lease purchases to be considered part of what is being reimbursed at the higher rate. That was a significant policy change."

Even with the call to accelerate meaningful use implementation in rural areas, Worzala notes that many critical access hospitals will still find it challenging getting HIT vendors to "pay attention" to their needs.

"Of course rural hospitals are not the largest clients and we are very much in a situation where demand outstretches supply for vendor solutions," she says.   

Burgess says TVHD ran into a string of problems with the HIT vendor they'd contracted.

"We ended up debugging a lot of their software. That was very frustrating for the staff. We are still working out the issues. It is a continuous process of improvement but we are getting there," he says.  

"With that incentive money, so many hospitals have contracted and gone out and tried to make it work that we have overwhelmed the industry to the point that industry is no longer capable of providing the level of support that I want, need, and expected with an installation startup and training for a new system."

As for whether or not ONC can reach its goal of meaningful use attestation for 1,000 rural hospitals by 2014, Missourian Slabach tempered his optimism with Show Me State skepticism.

"That would be yet to be seen," he says. "But we do have to have a goal and concentrating everyone's efforts toward those goals and seeing what policy levers we need to change in order to accelerate this migration is important."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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