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AHA urges policymakers to realign IT rules so program leaves no one behind

July 26, 2013

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The AHA July 24 told the Senate Finance Committee that the “digital divide” among urban and rural hospitals could widen unless the department of Health and Human Services (HHS) expands “meaningful use” timelines and makes the electronic health record (EHR) incentives program more flexible for providers.

The association said the EHR incentives will have the “best outcome if current regulations are realigned to ensure a safe, orderly transition to the next phase of the program that leaves no one behind.”

In a statement for the committee’s hearing on health information technology (IT), the AHA said hospitals are working hard to adopt EHR and realize the payment incentives provided under the meaningful use program. But the significant IT investment required for EHR adoption poses an immense challenge for many hospitals, especially small and rural ones.

“The majority of hospitals have yet to meet the exceedingly complex federal requirements for meaningful use of EHRs,” the AHA told the committee.

“If they cannot, the needed
incentives will quickly turn into financial penalties.”

Under the “Health Information Technology for Economic and Clinical Health” or HITECH Act, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified meaningful use objectives – measurable benchmarks providers must meet to qualify for the incentive payments.

Meaningful use has three stages with goals for each stage:

Stage 1: Data Capture and Sharing ? Electronic capture of health information in a structured format; Stage 1 began in 2011.

? Stage 2: Advanced Clinical Processes ? Quality improve

ment at the point of care and electronic exchange of infor

mation; Stage 2 is scheduled to begin in 2014.

? Stage 3: Improved Outcomes ? Improvements in quality, safe ty and efficiency, with clinical decision support and patient self-management tools; Stage 3 is scheduled to begin in 2016. In its statement, the AHA noted that a recent study? coau thored by the association and published in Health Affairs

? found 44% of hospitals had at least a basic EHR system in 2012. But large urban hospitals continue to outpace small and rural hospitals in EHR adop tion rates (see table at right).

"HHS can and should modify its regulatory timelines and allow more flexibility in the Stage 2 requirements," the AHA said. The association's recommendations include: ? allowing providers at Stage 1 to continue using their existing certified EHR ? the 2011 edi tion ? if they choose to, rather than the 2014 edition; ? extending each stage of mean ingful use to at least three years for all providers; ? setting a 90-day reporting period for the first stage of each new stag of meaningful use for providers; ? giving providers greater flex ibility to meet Stage 2 by stretching full compliance over three years and simplifying complex measures; and ? redirecting electronic clinical quality reporting require ments to focus on a small set of "well-tested measures supported by a mature policy infrastructure that can guide valid and feasible measure development, testing and implementation." The AHA said these changes "could keep the program mov ing forward on a more reason able pathway, and allow all providers to participate." For more on the statement, click on: http://tinyurl.com/lxo53qy .

The AHA also sent those recommendations to HHS Secretary Kathleen Sebelius in a joint July 23 letter with the American Medical Association. The groups noted that "time is of the essence in addressing these concerns." For more on the letter, click on: http://tinyurl.com/l9y4n4z .

Rural hospital concerns. At the Finance committee hearing, a rural hospital leader testi fied that financial constraints, workforce shortages and a lack of health information technol ogy (IT) vendors are hindering rural hospitals' efforts to meet "meaningful use" standards.

"Policymakers will need to make changes to the meaning ful use program to ensure small and rural hospitals are not left behind as we make the transi tion to Stage 2 of meaningful use," said Marty Fattig, CEO of Nemaha County Hospital in Auburn, NE.

Fattig told the committee that most rural hospital have not met Stage 1 requirements, and "worry that time is running out as the positive incentives quickly turn to penalties." They are concerned about the pro gram's complexity and "aggres sive timelines," he said.

Fattig called for changes along the lines of those recom mended by the AHA, and he urged policymakers to "refocus efforts on achieving widespread adoption and efficient informa tion exchange."