"Some important improvements" have been made, he said, but there are still many hurdles to clear. "We continue to be concerned that, given limited vendor capacity and workforce shortages, many hospitals will not have timely access to certified products, since no certified EHR systems are available today," Umbdenstock said.
Don May, AHA vice president for policy, said the biggest hurdle may be the traffic jam that the timing of the rules creates. "Everyone is going to vendors at the exact same time,” he said. “They created a market that looks like the Capitol Beltway at rush hour."
Among the AHA's biggest problems with the rules is the fact that some multicampus hospitals are slated to receive smaller subsidies because they share a single Medicare provider number. Another concern is that some multicampus hospitals won't receive incentives at all if a new campus uses the latest gadgets but older facilities still chug along on paper. In other words, this is no Cash for Clunkers program.
At Henry Ford Health System, Darlene Burgess, vice president of corporate government affairs for the Detroit-based system, said this policy could result in the loss of about $3.5 million in subsidies. For New York's three-campus Montefiore Medical Center, CEO Steven Safyer said, the figure is significantly higher. “It's about a $25 million hit to Montefiore,” he said, explaining that the CMS views Montefiore's three facilities, each with roughly 500 beds, as one 1,500-bed hospital for most uses—but, under meaningful use, it will receive the same subsidy as a single 500-bed hospital.
That's if it gets any money at all, Safyer said, given that even though two of its campuses have had CPOE fully implemented since 1999, its third campus—the former Our Lady of Mercy Medical Center (now Montefiore Medical Center, north division)—is behind the IT curve.
"We're being penalized for saving a hospital," Safyer said of the then-bankrupt Our Lady of Mercy, which Montefiore bought in July 2008.
At a July 13 news conference, Tony Trenkle, director of CMS' Office of E-Health Standards and Services, said the agency reviewed the issue and decided that treating the different facilities within a multicampus hospital as separate entities might cause problems elsewhere. "The point is to maintain consistency across various programs," Trenkle said.
Safyer said Montefiore's decision to share a provider number with the former Our Lady of Mercy center reflected the "best advice from CMS" on how to manage the latter facility after its purchase. Both Safyer and May expressed optimism that they could generate bipartisan support in Congress for overturning the rule. For the most part, however, Safyer said he thought the new rules could be a positive force in pushing wider adoption of health IT.
"I'm pleased with the response of CMS—that doesn't mean I think it's perfect, but what's best for the patient is to get everybody up to the same level," Safyer said.
Robert Tennant, senior policy adviser for the Englewood, Colo.-based Medical Group Management Association, took a similar approach, saying that he was generally pleased with the final rules. But he warned practices that, regardless of the subsidies, it will still require sacrifice to implement an EHR.
Tennant also cautioned physicians to beware rogue consultants. Doctors may well be approached by the same individuals who offered to protect them from a Y2K disaster or make them compliant with the Health Insurance Portability and Accountability Act of 1996, now promising to direct them to the meaningful-use pot of gold.
"The same people are morphing into these experts, and because most practices don't have the in-house expertise, they turn to these consultants," Tennant said, adding that networking offers the best protection against rogue advisers.
"There's a lot of money on the line, and it's not the practices that will get this money—it's the vendors," he said. "The practices are just the conduit for this money."
—with Matthew DoBias