A study from Mathematica Policy Research and the American Hospital Association, published in Health Affairs, finds many critical access hospitals and other smaller hospitals are at risk to fail achieving meaningful use and face Medicare payment penalties in 2015.

With fewer than half of all hospitals having a basic EHR in 2012, smaller and rural hospitals “appear to be less likely than other hospitals to have met the Stage 1 criteria, and very few hospitals had all of the computerized systems necessary to achieve Stage 2 meaningful use,” authors contend.

Between 2011 and 2012, the percentage of hospitals with at least 200 beds receiving meaningful use payments more than doubled, yet those with less than 100 beds had a lower rate. Teaching hospitals also had a higher meaningful use success rate than non-teaching hospitals. The proportion of critical access hospitals that received a meaningful use payment in 2012 declined slightly from the previous year. “Furthermore, smaller proportions of government-owned and nonprofit hospitals received payments, compared to the proportion of for-profit institutions.”

While meaningful use has led to increased adoption of EHRs, much work remains to be done, according to the study. “The majority of eligible hospitals did not achieve meaningful use in the first two years of the program. Furthermore, certain types of hospitals--particularly smaller institutions--were less likely than others to have received incentive payments. These findings suggest that at least as of the conclusion of the program’s first two years, the digital divide persists.”

Critical-access and smaller hospitals in particular face three tough challenges, the study notes:

* Low patient volume complicates long-range planning and limits ability to maintain adequate cash flow,

* The hospitals may not be able to offer competitive salaries for skilled information technology professionals, and

* Smaller hospitals may have difficulty finding a suitable I.T. vendor.

Study authors made a number of recommendations aimed at policymakers paying more attention to the meaningful use needs of critical-access and smaller hospitals. “Without the full participation of these hospitals, the nation will not be able to achieve the larger policy goal of sharing data across providers and ensuring that clinical information follows patients wherever they receive care.”

The study, “Some Hospitals are Falling Behind in Meeting ‘Meaningful Use’ Criteria and Could Be Vulnerable to Penalties in 2015,” is available here. Another study from the Office of the National Coordinator for Health Information Technology, which notes the growth of health information exchange since 2008 as providers adopted EHRs, is available here.

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