Small, critical access hospitals not meeting Meaningful Use

Many critical access hospitals and other small hospitals are at risk of not achieving Meaningful Use and the coming associated Medicare payment penalties beginning in 2015.

According to a study from Mathematica Policy Research and the American Hospital Association, published in Health Affairs, with fewer than half of all hospitals having a basic EHR in 2012, smaller and rural hospitals “appear to be less likely than other hospitals to have met the Stage 1 criteria, and very few hospitals had all of the computerized systems necessary to achieve Stage 2 Meaningful Use.”

Between 2011 and 2012, the percentage of hospitals with at least 200 beds receiving Meaningful Use payments more than doubled, but those with less than 100 beds had a lower rate. Teaching hospitals also had a higher Meaningful Use success rate than non-teaching hospitals. The proportion of critical access hospitals that received a Meaningful Use payment in 2012 declined slightly from the previous year. “Furthermore, smaller proportions of government-owned and nonprofit hospitals received payments, compared to the proportion of for-profit institutions.”

There's been much press coverage of the success of Meaningful Use but there is a digital divide among hospitals. “The majority of eligible hospitals did not achieve meaningful use in the first two years of the program. Furthermore, certain types of hospitals--particularly smaller institutions--were less likely than others to have received incentive payments. These findings suggest that at least as of the conclusion of the program’s first two years, the digital divide persists.”

Critical-access and smaller hospitals in particular face the following three tough challenges, the study notes:

• Low patient volume complicates long-range planning and limits ability to maintain adequate cash flow;
• The hospitals may not be able to offer competitive salaries for skilled information technology professionals; and
• Smaller hospitals may have difficulty finding a suitable IT vendor

Study authors made a number of recommendations aimed at policymakers paying more attention to the Meaningful Use needs of critical access and smaller hospitals. “Without the full participation of these hospitals, the nation will not be able to achieve the larger policy goal of sharing data across providers and ensuring that clinical information follows patients wherever they receive care.”

Access the complete study, “Some Hospitals are Falling Behind in Meeting ‘Meaningful Use’ Criteria and Could Be Vulnerable to Penalties in 2015,” is here.