Nearly thirteen-hundred Critical Access Hospitals (CAHs) that serve over fifteen million Americans in small, mostly rural, communities are excluded from the new health information technology incentives in the proposed Economic Recovery and Reinvestment Act (in H.R. 598). The draft language in the Act effectively excludes CAHs from receiving incentives for EMR adoption even though CAHs average just 1.3 on the HIMSS EMR adoption scale, while General Medical/Surgical hospitals average 2.4. (The HIMSS EMR adoption scale is the nationally recognized standard scale for determining provider EMR adoption rates)
Our smallest hospitals and the rural communities they serve are barred from the vast majority of the Act’s Health Information Technology (HIT) investment, which will revolutionize (1) HIT adoption, (2) HIT-related quality reporting and evaluation, and (3) healthcare information exchange.
It’s difficult to imagine how this could have happened when many HIT advocates have indicated the importance of small hospital inclusion. According to the well known E-Health Initiative, “Special attention should be paid to those with little access to capital, particularly in the current economic environment, including small physician practices, hospitals, and those who support underserved communities.” Rather than receiving special attention, small hospitals and the communities they serve have been effectively shunned from participation in the future of HIT-driven, quality-focus healthcare.
The rationale for this policy decision is difficult to understand. While certainly behind larger hospitals, CAHs throughout the country have shown they are capable of substantial Electronic Medical Record (EMR) adoption, with adoption increasing. Many inpatient EMR vendors that serve CAHs have been certified by the Certification Commission for Healthcare Information Technology and offer the functionality to take CAHs to the highest level of EMR adoption. But this takes an investment out of reach for many CAHs. Due to the specific challenges that small hospitals face, EMR implementation, a prerequisite for clinical information exchange, is particularly important in the small hospital setting.
If not addressed, this flaw in this legislation will result in grave damage to rural and small providers/communities. As most hospitals are subsidized to implement comprehensive EMRs, small hospitals, already lagging, will get even farther behind. The continuity of care between small hospitals and their tertiary partners will remain fractured, since clinical data will not be available for exchange. Small hospitals will in many cases be forced to rely on the large hospitals that have been subsidized, which will strike at community hospital independence. Most important, the underserved residents in small and rural communities will be largely deprived of the efficient, quality healthcare that it is the goal of this legislation to deliver to all other Americans. CAH exclusion in the Economic Stimulus Bill should be reconsidered in favor of HIT for all providers and the communities they serve.
Tim Size, Executive Director
Rural Wisconsin Health Cooperative
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