Feds Want 1,000 Rural Hospitals On EHRs By 2014

The U.S. government is funneling as much as $30 million through its Regional Extension Center (REC) program in an effort to get 1,000 federally designated "critical access hospitals" and small, rural hospitals to adopt electronic health records (EHRs) and achieve Meaningful Use by 2014.

The Kansas City, Mo.-based National Rural Health Association (NRHA), which represents these classes of hospitals, is on board with the plan but still sees obstacles ahead.

The Office of the National Coordinator for Health Information Technology (ONC) has challenged the smallest and most remote of the nation's hospitals to accelerate their progress toward Meaningful Use before Medicare penalties for noncompliance start in 2015.

"To realize this goal, we need all hands on deck. We need everyone rowing in sync, 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," wrote Mat Kendall, director of the ONC Office of Provider Adoption Support, and Leila Samy, rural health IT coordinator at ONC, in a jointly bylined blog post.

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The $30 million in funding could help as many as 1,501 rural hospitals, or 90% of those covered by the government's Small Rural Hospital Improvement Program achieve Meaningful Use, according to Kendall and Samy. "We are committed to working with all 1,501 of these hospitals and we want them all to achieve Meaningful Use. At the same time, we recognize that not every health care provider may achieve Meaningful Use in the next two years and we are committed to working with them at their own pace," they wrote.

This money is in addition to the $32 million in American Recovery and Reinvestment Act funding ONC previously committed to RECs to help health IT adoption at Critical Access Hospitals, which are rural facilities with no more than 25 beds and an average daily census of 10 or fewer patients. The ONC officials said that about 1,220 Critical Access Hospitals and other small acute care facilities have signed up for REC assistance.

For its part, the NRHA is enthusiastic about this challenge but is trying to stay realistic. "Generally, NRHA is very pleased to see ONC making this push. We think it's been overdue," Brock Slabach, NRHA senior VP for member services, told InformationWeek Healthcare. However, Slabach says he will be reserving judgment until he sees ONC's baseline tally for small hospitals that have already met Meaningful Use. ONC will allow NRHA to work with the Centers for Medicare and Medicaid Services (CMS)--the "keeper of the data," according to Slabach--to calculate the baseline.

Slabach, former CEO of Field Memorial Community Hospital, a 25-bed critical access hospital in Centreville, Miss., still sees three major hurdles that small hospitals will have to surmount to get to Meaningful Use in the next two years.

Critical access hospitals are eligible to receive a portion of Medicare Meaningful Use incentive payments earlier than other hospitals, but Slabach said CMS needs to be "more definitive" about what is considered an accelerated CAH payment because this can affect what a hospital can afford to invest in IT. "It really produces some uncertainty, and uncertainty produces paralysis," Slabach said.

He also cited the ongoing shortage of qualified health IT staff and the "panoply of changes and pressures" all healthcare providers are wrestling with right now. These include the conversion to ICD-10 coding, the shift toward outcomes-based reimbursement, and the 2014 expansion of the insured population as a result of the Patient Protection and Affordable Care Act.

The short timeline to get to Meaningful Use before penalties begin Oct. 1, 2014--the start of federal fiscal year 2015, which Medicare Part A follows--means that hospitals need to get started on EHR implementation in the next year or so, Slabach added.

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