Electronic Health Records

Adoption & Implementation News

How meaningful use eligibility affects non-meaningful users

By Kyle Murphy, PhD

- The effect of meaningful use eligibility on the adoption of EHR systems and capabilities by non-eligible providers is the subject of a recent study conducted by the American Health Information Management Association (AHIMA) Foundation.

The findings from a nine-month study undertaken by AHIMA’s 501 (c) 3 affiliate for the Department of Health & Human Services (HHS) conclude that those Medicare and Medicaid providers caring for “some of the most vulnerable and costly individuals in our society” and likely to benefit from care coordination and health information exchange (HIE) through meaningful use are in fact ineligible for this series of funding.

“One of the key benefits of the use of health IT for ineligible providers is the ability to exchange information to communicate and coordinate services with a patient, their physician, and the entire care team who are often located in different geographic areas and practice settings,” write the authors. “However, such HIE remains uncommon.”

Providers ineligible for EHR incentive payments fall into four categories:

Long-term and post-acute care: Home health agency (HHA), hospice, freestanding and hospital-based in-patient rehabilitation facilities, intermediate care facilities for individuals with intellectual disabilities (ICFs/IID), long-term acute care hospitals, and freestanding and hospital-based nursing homes.

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Behavioral health: Clinical social worker, community mental health center (CMHC), psychiatric hospital/unit including substance abuse, residential treatment centers (facilities for mental health and/or substance abuse) and clinical psychologist. Identifying providers included in the behavioral health cluster was particularly challenging in large part due to the historic blurring of behavioral health providers and the services provided by these entities.

Safety net: Federally qualified health center (FQHC) and RHC.

Other: Ambulatory surgical center (ASC), blood center, renal dialysis facility, laboratory, dietician/nutritional professional, pharmacist, pharmacy, and therapist (physical therapist; occupational therapist, speech-language pathology).

According to the study, these providers account for 51.1 million patients and $83.1 and $98.1 billion in total Medicare and Medicaid expenditures, respectively. And despite their financial impact, their adoption of EHR systems lags behind eligible providers although the exact percentages are difficult to calculate because the EHR technology is not comparable:

Even though some providers are fully electronic, most have only partially implemented a system and are maintaining hybrid processes (both paper and electronic). The majority of providers have limited or no capability to electronically exchange information and generally cannot support meaningful use functions related to transition of care. One group of ineligible providers — pharmacies, laboratories, ambulance services, and blood centers — appear to maintain specialized health information systems that share information with EHR technology, but these health information systems do not constitute an EHR system themselves. Some of these providers use specific health IT applications rather than the complete functionality of CEHRT. Further, some of these applications may need to support interoperable exchange with certified EHR systems.

Although funding is available to some of these ineligible providers, for instance $1.5 billion in funding intended to spur health IT adoption among safety net providers, the amount of financial resources made available to this subset of providers “was not considered to be sufficient in amount, duration, and scope to support widespread adoption and use of this technology by these ineligible provider types.” Furthermore, strategic planning and coordination of program and resources were also deemed lacking.

Beyond investing financially in programs or services to assist ineligible providers in adopting EHR systems and HIE functionalities, the study has identified other factors for policymakers to consider:

Built to last: Interventions should support the technology infrastructure needed for the emerging health care delivery and business models envisioned in the Affordable Care Act, the nationwide health IT infrastructure, and EHR Incentive Programs to allow for the interoperable exchange and reuse of health information.

Patient-centered: Interventions should promote a patient-centered approach to care delivery and outcomes empowering patients and their care support network.

Tailored and targeted: Interventions should not be “one-size-fits-all” but must consider the cost of adoption and the provider’s need for clinical utility and availability of the technology. It is likely that different technology solutions will be required to achieve policy goals for different ineligible provider types. Finally, the costs and benefits to Medicare and Medicaid should be a factor.

Smartly clustered: Interventions may need to be clustered to accrue the most benefit from the investment. Strategically considering and supporting the type of heath IT functionality (including certified EHRs) needed to realize policy goals may help remove some uncertainty in the market. Such support could accelerate adoption by some providers not eligible for EHR incentive payments, and could serve to reduce the amount, duration, and/or scope of incentives/other funding. In addition, direct support to implement health IT/CEHRT may need to include technical assistance and workforce initiatives to ensure implementation of technology is appropriate to achieve quality and cost goals by the targeted ineligible provider.

Spend wisely: In today’s fiscally constrained environment careful consideration should be given to the ineligible providers’ margins and ability to cover all or some of the cost of technology. In addition, consideration should be given to the availability (i.e., amount, duration, and scope) of other funding to support the acquisition and use of CEHRT by the targeted ineligible provider type(s).

Read the complete report here.




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