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More than 40 hospitals and delivery systems are giving advice to federal officials as they finalize proposed rules to implement the meaningful use provisions of the American Recovery and Reinvestment Act.

The organizations, working through the American Hospital Association, have sent a letter to three top policymakers outlining concerns with statutory or expected definitions for "hospital" and "hospital-based physician." The definitions of these entities will play a major role in determining eligibility for incentive payments for the meaningful use of electronic health records.

"We appreciate that we will have a formal opportunity to comment on these issues through the regulatory process, but feel it is important to highlight them now as they could create barriers to and prevent the widespread adoption of HIT," according to the letter. It was sent Dec. 4 to Nancy-Ann DeParle, director of the White House Office of Health Reform; Kathleen Sebelius, secretary of the Department of Health and Human Services; and Tony Trenkle, director of the Office of e-Health Standards and Services in the Centers for Medicare and Medicaid Services.

The hospitals and delivery systems worry that use of existing hospital identifiers, such as Medicare provider numbers or National Provider Identifiers, to define a hospital may seem to be the simplest solution.

"A number of health systems have one Medicare provider number for multiple hospitals," according to the letter. "Obtaining an individual provider number of each individual hospital would be time and cost-prohibitive, and in some cases may not be possible because of state laws. In addition, there is no standard approach to exactly what facilities a Medicare provider number or NPI encompasses."

Consequently, the hospitals and delivery systems recommend defining a hospital "as a discrete site of service, so that individual sites of multi-campus facilities are eligible to qualify separately for the incentives. CMS has avenues through which it could collect data by individual campuses, which would be consistent with the statute."

The hospitals also are concerned with the definition of hospital-based physicians in ARRA. "The law defines hospital-based physicians as those individuals who furnish substantially all of their services in a hospital setting using the facilities and equipment, including the EHR, of the hospital," according to the letter. "We are concerned that broad regulatory interpretation of this hospital-based physician definition may inappropriately exclude physicians practicing in outpatient centers and provider-based clinics merely because their office or clinic is located in a facility owned by the hospital."

Full text of the letter is available at
aha.org/aha/letter/2009/091204-let-hit-arra.pdf.

--Joseph Goedert