HITPC: Helping rural hospitals, CAHs cross the MU finish line

For rural hospitals, the number one barrier to achieving Meaningful Use (MU) attestation is acquisition of an EHR system, reported Centers for Medicare & Medicaid Services (CMS) Health Insurance Specialist Robert Anthony to the Health IT Policy Committee on Dec. 4.

Federal officials recently interviewed executives at rural hospitals (with fewer than 25 beds) and critical access hospitals (CAHs) on challenges to achieving attestation. They reached out to organizations that not only had registered for the program but had yet to attest, but also those that had succeeded in attesting to learn how they overcame challenges.

“Everyone we talked to had cited the fact that they were not able to get on board with vendors, and talked about the difficulty in evaluating which systems would be the most appropriate,” Anthony said.

Also, insufficient IT resources prohibited rural hospitals from making progress on attestation. Rural hospitals often do not have one dedicated IT professional; in fact, IT professionals often are shared between multiple buildings, making an EHR system particularly difficult to implement into the workflow, he said.

Other concerns frequently cited by rural hospitals:

• “Complicated” and “confusing” MU requirements
• Difficulty in meeting thresholds with a small patient population
• Relevance of quality measures
• Leverage for provider compliance

Factors that helped rural hospitals attest included strong consultant or vendor support. “Hospitals said it was money well spent,” Robert said. Also, rural hospitals that were part of a larger organization fared better than their counterparts, especially because they were able to secure the attention and support of a vendor, he said.

Program information from CMS also proved beneficial to rural hospitals, according to the interviews.

Currently, CMS is focusing on creating resources within the next six to nine months that are tailored to rural hospitals. “The feeling from providers is that we didn’t have enough resources focused on them and their circumstances. We are implementing training modules, webinars with direct Q&A to answer questions specific to meeting their objectives.” The agency also is working with partner organizations to provide EHR product information to help rural hospitals choose a vendor and to assist with implementation and financial planning.

Matt Kendall, MPH, director of the Office of Provider Adoption Support in the Office of the National Coordinator for Health Information Technology (ONC), said CAHs continue to make strides in attesting to MU, but much work remains to be done.

“I’m constantly amazed at the ingenuity and resourcefulness of what goes on in rural America,” he said, adding, “They get the potential of health IT and understand population health.”

As of July 2013, he said 822 of 1,332 (62 percent) of CAHs have achieved MU. Those that have yet to attest cite barriers including EHR implementation costs, availability of grants and loans, lack of broadband access, difficulties with adequate IT workforce and staffing, and technical challenges to meet security and privacy rules.

To help link rural providers with resources, Kendall said ONC and the USDA Rural Development have launched an initiative to expand funding for CAHs and rural hospitals. He said a pilot in FY 2013 distributed $38 million in funding to rural providers across four states. Due to its success, they are expanding the program nationwide in FY 2014.

“These dollars are critically important to getting folks to achieve Meaningful Use,” he said.