Louisiana hospitals, like those everywhere else in the country, will have a hard time meeting the Stage 2 requirements for meaningful use of certified electronic health records, according to a Louisiana Hospital Association executive.
“It is something that our hospitals are struggling with to meet the deadline. Although they’ve made substantial progress, we are concerned about this new requirement putting those hospitals that are lagging just further behind,” said Rebecca D. Bradley, LHA associate vice president of Rural Health Programs.
Under the Centers for Medicare & Medicaid Services’ proposal, hospitals must provide, among a variety of other things, a web portal that allows patients to view, download and transmit their health records. Previously, hospitals would have had to provide patients with an electronic copy of their health information.
Bradley said what CMS now proposes is a lot different than the previous requirements and follows “an extremely aggressive timeline.”
“It really takes the vendor community, that’s already stretched thin for implementation, and puts it that much further behind,” Bradley said.
Vendors will now have to take some of the people they have working to implement electronic health records to further develop their software code, according to Bradley. This means the EHRs won’t be implemented in as many hospitals.
“The curve just keeps getting steeper, when you look at it and project it over the next couple of years,” Bradley said.
The EHR program was part of the 2009 federal economic stimulus package. Under the program, hospitals that demonstrate “meaningful use” can qualify for up to $11.5 million in payments. But hospitals and physicians who don’t adopt EHRs by 2015 will have their Medicare payments cut.
The American Hospital Association has issued a 68-page letter to CMS, protesting the proposed Stage 2 requirements and schedule.
In the letter, AHA Executive Vice President Rick Pollack says more than 80 percent of hospitals and physicians haven’t met the Stage 1 requirements, in part because of accelerating costs and vendors’ limited ability to handle the demand.
“Taken as a whole, the proposed requirements for meeting Stage 2 raise the bar too high and are not feasible for the majority of hospitals to achieve,” Pollack said.
The CMS list of Medicare-eligible hospitals that have achieved meaningful use as of March includes 24 of the state’s 125 hospitals, or 19.2 percent.
Bradley said Louisiana’s rural hospitals, like their counterparts nationally, are having a harder time with the EHR requirements.
A lot of vendors don’t even market to rural hospitals or the rural providers, Bradley said. There are only three or four in Louisiana that even target that piece of the market.
“When you’re competing for your vendor’s time and attention, on top of the price and just having limited resources and a restricted timeline, it all kind of starts to pile up on you,” Bradley said.
In his letter, Pollack says hospitals are particularly concerned about the patient portal requirement.
The new proposal doubles the functional requirements of the portal. The AHA believes this will result in unintended consequences by increasing the complexity of the program and the burden of measurement and reporting.
The portal is not feasible as proposed, raises significant security issues, and goes well beyond hospitals current technical capacity, Pollack says.
Hospital systems must also be capable of identifying and reporting cancer cases to a state cancer registry, according to the CMS proposal. Hospitals would also be required to report 24 clinical quality measures.
CMS says it recognizes that for clinical quality reporting to become routine, the administrative burden of reporting must be reduced.
In his letter, Pollack says hospitals have had “significant difficulty” in using EHRs to report the clinical quality measures required for Stage 1 meaningful use. The problems included inaccurate e-specifications to certified vendor products that were unworkable.
“The AHA believes that Stage 1 of meaningful use was about getting started with automated clinical quality measurement. We want Stage 2 to be about getting it right,” Pollack says.
Bradley said Louisiana’s healthcare providers mirror the national average on achieving meaningful use.
Meanwhile, Louisiana’s physicians haven’t exactly rushed to implement electronic health records. A joint 2011 report by LSU and the Louisiana State Medical Society found that physicians didn’t trust the two groups pushing for EHR systems, the federal government and insurance companies.
Physicians also felt they were being pushed into an unproven technology through the use of penalties or incentives.
LSMS spokeswoman Sadie Wilks said the study was so successful, that the Medical Society has won a grant to take the study nationwide.
In April, the LSMS Education & Research Foundation was awarded a $35,000 grant from The Physicians Foundation for its project titled, Exploring the Role of Inhibitors in EMR Non-Adoption.
The grant will help fund a study to determine what prevents physicians from implementing electronic health records, Wilks said.