Small hospitals on the radar

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.