Meaningful Use may unintentionally increase care disparities

I read with great interest this week my colleague Ron Shinkman's thought-provoking commentary about how the 25 states that have refused to expand Medicaid eligibility pursuant to the Affordable Care Act and rejected billions of federal dollars could ultimately degrade the quality of their patients' care. Shinkman, editor of FierceHealthFinance, noted that hospitals in at least one of these states have already started laying off staff, which often impacts the quality of care provided.

It's a new twist on the "have vs. have not" debate. The rich get richer, the poor get poorer.

I worry that the Meaningful Use incentive program is creating a similar dichotomy. Attaining Meaningful Use is much more elusive for hospitals with fewer resources, further widening the "digital divide." Research published this summer found Meaningful Use progress "uneven," with smaller, critical access hospitals struggling, a finding that was corroborated by a recent GAO study. What's more, the Centers for Medicare & Medicaid Services recently reported that while 70 percent of community health centers--which typically treat lower income patients who either are uninsured or Medicaid beneficiaries--have adopted some sort of electronic health record system, only a scant 9 percent have met the Meaningful Use requirements, despite support from the Office of the National Coordinator for Health IT's regional extension centers.

That's quite a disconnect. The "haves" are earning the incentives, which in some cases amount to millions of dollars, while the "have nots" can't seem to cut the mustard.

But earning the incentive payment is not the real issue here. EHRs are intended to improve outcomes, increase efficiencies and lower healthcare costs. Hospitals that can't fully implement EHRs will not enjoy these benefits.

And since starting in 2015, hospitals will be penalized for not meeting Meaningful Use, it won't be long before those hospitals already struggling will be left with even less money to treat patients. So what happens then? They'll likely fall even further behind. They'll probably be forced to cut staff. Some may even have to shut their doors.

This could quickly spiral out of control.

And who will suffer the most? Those hospitals' patients, of course.

This is yet another unintended consequence of the Meaningful Use program.

Unfortunately, the solution to this Meaningful Use disparity among hospitals isn't so simple. Some suggestions include extending Stage 2 of the program so that lagging providers can come up to speed, or providing additional assistance to struggling hospitals. Those, however, are short-term fixes. The real issue is how to maintain quality of care for all Americans.

The good news is that at least the digital divide problem has been recognized by many stakeholders, including both the executive and legislative branches of government. Let's hope that the government doesn't engage in its own divide and will work together to solve it. - Marla (@MarlaHirsch @FierceHealthIT)

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