Small hospitals less ready for "meaningful use" mandate

Smaller hospitals are less prepared to meet "meaningful use" requirements, compared with larger facilities, according to a recent survey by the College of Healthcare Information Management Executives.

The survey found that of the 152 hospitals responding, 28% expect to qualify for stimulus funds in the first six months of 2011. That means these organizations would need to be ready to start demonstrating meaningful use by October, because the rules require a 90-day period of consecutive meaningful use.

For hospitals with 100 to 199 beds, two-thirds say they expect to get funding within the first two years that stage 1 of the stimulus program is in effect. Nearly all surveyed hospitals with 600 to 999 beds expect to qualify within the first two years.

Keith Fraidenburg, CHIME's vice president of education and communications, said in rural communities, hospitals and physicians are relying on each other to help meet meaningful use. But neither has much to offer the other in terms of help.

Because smaller hospitals have a small percentage of physicians who are employed, they will rely heavily on their affiliated physicians to meet meaningful use criteria, Fraidenburg said.

Affiliated doctors will need to use the hospitals' electronic medical records systems to enter orders and perform other tasks required under meaningful use rules.

But doctors relying on hospitals to help them purchase their own EMRs, through allowances under Stark law exemptions, may be out of luck.

Capital budgets are small, and getting EMR systems in hospitals will be a large financial burden with little money left to help affiliated physician practices, Fraidenburg said. "I would not want to be a physician in this environment."

He said physicians affiliated with academic hospitals, however, may have an easier time, because many of these facilities are better equipped to offer doctors subsidies to help them purchase an EMR.

There haven't been many surveys looking at overall readiness of physician practices to meet meaningful use since the rules were finalized in July. But there have been surveys showing doctors who have adopted EMRs stand a good chance of qualifying.

KLAS, an Orem, Utah-based research firm, published results from a survey of 1,400 physician practices that have ambulatory EMRs in place. The report found 85% believed their EMR would enable them to meet meaningful use requirements.

The Healthcare Information and Management Systems Society published a survey in the September issue of Vantage Point that looked at pursuing meaningful use incentives.

The survey of 126 HIMSS members found that only 8% have the ability to demonstrate meaningful use for 90 days, and 10% said they would be ready by Jan. 1, 2011. Forty-five percent expect to be ready in 2011.

Fraidenburg said there is a carrot-and-stick approach going on to encourage EMR adoption. And there are really two sticks physicians could be beaten with, he said.

"One of them is the Medicare penalty stick. The other is the hospital stick, and maybe even the payers. If [physicians] haven't done what they need to do to achieve meaningful use," they will be left behind.

He expects many physicians who don't have EMRs to ride things out until it gets closer to 2015, when incentive payments turn into penalties. Meanwhile, he expects many to seek employed positions at the hospitals to avoid EMR adoption on their own.

"There's the carrot, which is incentive payments, and I'm not sure how much of an incentive that is for a small practice. ... On the other hand, for hospitals and health systems we're talking potentially millions of dollars," Fraidenburg said. "So when you look at it from the physician perspective ... I think they are probably more worried about the stick."