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Meaningful use incentives, compliance raise concerns for hospital execs

Hospitals remain unconvinced they can meet even the relaxed criteria for meaningful use. Smaller incentives, which reward only a whole campus, not each facility, fail to help.

Hospitals analyzing the meaningful use final rule say they still face some struggles in meeting the criteria -- but their larger concern is how meaningful use incentives will be allocated.

The final criteria have more flexibility, but smaller hospitals will still have difficulty implementing technology that meets the requirements, such as computerized physician order entry, or CPOE, according to Phyllis Teater, interim chief information officer for The Ohio State University (OSU) Medical Center in Columbus. "They certainly need the incentive funding the most."

The final rule, dubbed the Electronic Health Record Incentive Program, defines what it means to be a meaningful user of health information technology, and spells out in detail how providers wishing to qualify for meaningful use incentives can become meaningful users. Some $27 billion over the next decade is up for grabs among doctors and hospitals that adopt electronic health record (EHR) and other health IT systems that pass federal muster.

Hospitals will be able to qualify under both the Medicare and Medicaid components of the incentive program, and the rule explains how to register and qualify for payments. But the final rule limits meaningful use incentives to facilities operating under their designated Medicare numbers. Hospitals with multiple facilities under one number will receive only one incentive payment -- a point of contention among large health systems with several hospitals and clinics in their networks.

Different hospitals in a system tend to serve disparate populations and have separate workflows and separate staff, Teater said. Treating a small, 50-bed facility the same as, say, a major urban campus with 900 beds "is a problem that's going to affect sites around the country."

We have an opportunity to really deliver a better clinical model. We can't get lost in the software.

Rex Vaughn, executive director of information systems, Owensboro Medical Health System

The OSU Medical Center has estimated it could receive about $10 million in meaningful use incentives. However, because of the designated Medicare number, it also determined that one of its smaller hospitals will lose out on $5 million that would be vital to helping the facility implement IT, Teater added. The center, which says it is on track with implementation and can begin meeting meaningful use criteria in 2012, is evaluating the costs involved for building out EHR systems across its physician offices and clinics.

In Kentucky, Owensboro Medical Health System, which comprises one major hospital and a network of ambulatory settings, is studying its implementation needs in reverse. The system had focused on implementing IT in its network of facilities first. Now it's turning its focus to the main hospital, said Rex Vaughn, executive director of information systems. "When the physicians see how [EHRs] can benefit them, it's easier on the hospital side."

The Owensboro health system, which started its EHR implementation projects three years ago with nursing and physician documentation applications in the clinics, estimates it will be eligible for $5 million to $7 million in incentives. The system feels comfortable with the criteria for complying with meaningful use, Vaughn said, but there is still ambiguity around the process for meeting the criteria. "There's still a fair bit of interpretation," he said, and that is a concern for executives.

Still, Vaughn said, it is easy, throughout the details of the meaningful use criteria, to lose sight of the goal -- quality improvement. "We have an opportunity to really deliver a better clinical model," he said. "We can't get lost in the software."

Let us know what you think about the story; email Jean DerGurahian, News Writer.

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