Small providers feel cost squeeze of meaningful use

Small and rural healthcare providers told a federal health IT advisory panel that they may not be able to afford what it takes to meet “meaningful use” requirements in 2011 unless the policies are changed or funding is made available to them sooner.

In remarks to the Health IT Policy Committee yesterday, officials representing smaller community practices and medical specialists said they are concerned that meaningful use multiplies the reporting requirements they face without providing upfront funding to comply with the new rules.

Their over-riding concern is cost, the executives said. Start-up expenses, as well as the ongoing financial environment, will be hurdles to achieving meaningful use, they claimed.

“Critical access and other small hospitals must find significant funding resources … regardless of whether they are already providing high-quality care,” Marty Fattig, chief executive officer of Nebraska’s  20-bed Nemaha County Hospital, told the Committee..

The expense of software licenses alone are beyond what many smaller health centers can afford, according to Michael Lardiere, director of health IT for the National Association of Community Health Centers.

Costs could run $100,000 at $5,000 per license for each of a clinic’s 20 providers, Lardiere said. He recommended that the federal government make funds available upfront to help small providers purchase the technology and defray the cost of fulfilling meaningful use.

“Unless these funds are available the adoption of EHRs may be stalled,” Lardiere said. Under the stimulus law, providers are eligible for Medicare and Medicaid incentives only after they demonstrate meaningful use.

Small providers will also face a number of other hurdles equipping their health IT systems to meet meaningful use standards, they said. For example, many community health centers now report data that helps federal officials track the quality of healthcare  provided to their patients. Meaningful use will only add another layer of reporting to that burden.  

“The current meaningful use reporting measures differ from what health centers are required to report,” Lardiere said.

However, only a few vendors of certified electronic EHRs support the registries these health centers use to make their reports to the Health Resources and Services Administration program. More requirements might overtax their systems, he said.

“Until this functionality is fully incorporated into electronic health records, federally qualified health centers will be required to integrate two different systems in order to be able to track and report on its required activities,” Lardiere said.

Others said the current meaningful use framework should be more in sync with the typical adoption path of smaller providers.  

“Certain system functions must be in place before other functions can be successful,” said Nebraska’s Fattig. For example, nursing documentation and pharmacy functions must be in place before computerized physician order entry can be available.

“Meaningful use objectives and measures should be defined in this same order, and by use of the system functions necessary to improve patient care,” he added.

Likewise, reporting requirements should be realistic. “Scarce time, money and professional resources should focus on transforming the information flows and processes within the hospital,” Fattig said.

Safety net providers said the recession and accompanying job losses have added even more strain to their operations.

Dr. Andrew Steele, director of medical informatics at Denver Health, said that his health network has experienced a dramatic increase in the number of uninsured patients. In addition, states are reducing their reimbursements for Medicaid patients, he said.  “We are predicting a total of $362 million in uncompensated care in 2009,” he said.

At the same time, Denver Health has spent $330 million over 10 years on health IT. He also recommended that grants and loans be made up front to help safety net providers acquire the technology necessary to participate in the adoption plan.