Thousands of hospitals and office-based physicians will have either cash or knives heading their way in 2013 as the federal government tries to either entice or coerce latecomers to adopt and effectively use electronic health-record systems to improve patient care and control costs.
The pressure will come down most heavily on the smallest and most rural of these providers that are lagging in EHR adoption.
As of November, the feds had paid out $9.3 billion through a pair of EHR incentive payment programs under Medicare and Medicaid created under the American Recovery and Reinvestment Act. Three out of four hospitals and one in three physicians and other “eligible professionals” had been paid under the two programs, according to the CMS data. Yet only 283 critical-access hospitals—or just 21% out of a total of 1,329 such hospitals—had been paid under the Medicare program, compared with 48% of the remaining 3,602 larger and more urban hospitals.
“If you're looking at your digital divide story, there it is,” said Chantal Worzala, policy director for the American Hospital Association. “All of this, from our perspective, continues to raise questions about the pace as HHS is continuing to implement this program. It's a remarkably fast pace.”
If only such a small fraction of critical-access hospitals have made it to Stage 1 criteria for meaningful use of EHRs after the second year of the program, Worzala reasons, “does it make sense to raise the bar in another year? I think there are a lot of questions about vendor capacity and workforce capacity to support this level of time pressure in a program where we're trying to get to widespread adoption.”
For hospitals, whose Medicare EHR incentive program operates on a federal fiscal-year calendar, the clock started Oct. 1 on the period in which 2015 Medicare penalties will be based.
There is a one-time exception for hospitals first attest to meaningful use. “Instead of looking back two years, you look back 14 months,” Worzala said. For a hospital to be a first-time meaningful user and avoid the 2015 penalty, it has to complete its 90-day meaningful-use demonstration period by July 1, 2014.
Meeting even that distant deadline is shaping up to be footrace for one tiny hospital in the Idaho panhandle.
Benewah Community Hospital, a 19-bed critical-access hospital in St. Maries, Idaho, has implemented pieces of an EHR—labs, pharmacy, emergency room and administration modules that it's sharing with three other hospitals—but not its most challenging component, computerized physician order entry.
“We'll probably go live with CPOE in September and October,” said Brad Gardner, its director of information systems. Benewah will look for help from the North Idaho Rural Health Consortium, based in Coeur d'Alene, and the consortium's flagship 246-bed Kootenai Medical Center, also in Coeur d'Alene.
The Idaho consortium is running the EHR on a private cloud hosted by Dell in Kent, Wash., and connected to St. Maries through microwave relays. “We don't have any fiber here yet,” Gardner said. Benewah will wait on Kootenai to launch computerized order entry in April and learn from their experience, he said.
Working collaboratively is the only way Benewah, with its two-person IT staff, could have afforded to operate and maintain an EHR, Gardner said. He's optimistic about achieving Stage 1 meaningful use on schedule, but Stage 2 “is going to be a scramble to get it done.”
Physicians and other so-called eligible professionals face a Dec. 31 deadline to have met the meaningful-use targets of the Medicare EHR incentive payment program. Those physicians still on the sidelines come Jan. 1 will have lost the opportunity to maximize their Medicare incentive money. Payments drop from $44,000 in 2011 and 2012 to $39,000 in 2013 and $24,000 in 2014, the last payment year.
Physicians (who make up about 90% of all eligible professionals paid EHR incentives under Medicare) fall into three main groups in relation to the federal program, according to Robert Tennant, senior policy adviser for the MGMA.
The first group is “the forward-thinking that had technology already” Tennant said. Those early adopters were paid for 2011 and will be again for 2012.
According to the CMS, 107,543 physicians and other eligible professionals had received EHR incentive payments under Medicare through November of this year, while 62,625 physicians and other had been paid under Medicaid EHR incentive programs, which are largely funded by the federal government but run by the states.
Combined, that's about only about a third of the 521,600 total numbers of medical professionals eligible for the programs. They must choose one or the other, unlike hospitals, which can participate in both programs.
A second group was “kind of letting the dust settle and using the knowledge gained from the others,” Tennant said. “I think 2013 will see a pretty significant batch of those folks starting the program.”
Next year, however, physicians registered under the Medicare EHR incentive payment program face another deadline: Those who are not meaningful users in 2013 risk losing 1% of their Medicare reimbursements in 2015.
They could include physicians in Tennant's third group, which he said includes as many as 30% who are “just not going to do it.”
“They're older physicians who just are not going to make the investment when they're going to be retiring in a few years, Tennant said. “They're going to be the most difficult to convince” and “may not be able to do it.”