Some providers on the outside of EHR incentives--but trying to get in


Last week must have been an exciting time for some physicians and hospitals that had successfully demonstrated Meaningful Use of electronic health records (EHRs). Medicare finally began rolling out incentive payments to qualified providers. For many other healthcare providers, however, the dissemination of incentives probably didn't mean much, considering their exclusion from the $27 billion pot, at least for now.

Those providers include: nurses; behavioral health providers; cancer centers; emergency medical service providers; federally qualified health centers; home-care practitioners; long-term care providers; nurses, physician assistants; post-acute care providers; rehabilitation hospitals; and rural health centers.

The reason for their exclusion? In an article published this week by The Center for Public Integrity, it becomes apparent that they didn't move fast enough for inclusion with the other healthcare providers.

In the fall of 2008, Rep. Pete Stark (D-Calif.), then chairman of the House Ways and Means health subcommittee, sponsored a bill in which incentives were directed toward physicians and hospitals. While the measure never left the committee, it created a template for what would become the HITECH bill, which emerged from the $787 billion stimulus package that President Obama signed on Feb. 17, 2009.

And like most legislation on Capitol Hill, the economic stimulus package already has been changed numerous times. When the dust cleared up, physicians and most hospitals--along with chiropractors, dentists, optometrists, podiatrists, and psychiatrists--were on the receiving end of the proposed incentives.

According to one health policy observer, the healthcare providers who were left out of the programs traditionally in the past had not had great success advancing their agendas with Congress this time as well.

Another observer said that the House Energy, Commerce, and Ways and Means committees--in meeting with the non-eligible healthcare providers--said that the goal of the stimulus funding was to achieve "maximum effect," rather than make sure everyone got a piece of the funding pie.

That's a strange way to look at it--especially now with emphasis in the healthcare community of coordinated care and seamless transitions by patients from one care entity to another. It would seem to be a top goal to get everyone moving toward EHR adoption--to have them on the same page (with some incentives to sweeten the deal).

There is some good news for those groups on the outside of EHR incentives. Farzad Mostashari, MD, the new national coordinator for health information technology, was quoted as saying that he does not think the Office of the National Coordinator can meet its goals of improving care through health IT unless--unless all providers can track patient records across the care continuum.

The bad news, though, is that the likelihood of legislation to expand the stimulus funding for EHR adoption is small--given the current fiscal constraints on Capitol Hill.

Still, some providers refuse to give up. Those representing behavioral health interests were heard by Sen. Sheldon Whitehouse (D-R.I.) who introduced bill (S. 539) in March that would make health IT incentive payments available to behavioral healthcare providers.

Meanwhile, groups such as the American Academy of Physician Assistants have targeted members of Congress--calling for them to amend HITECH and extend Medicaid incentives to physician assistants if at least 30 percent of their patients are on Medicaid.

Will these strategies work to get those provider groups from the outside of the EHR incentives to the inside? With the fiscal situation in Congress, it will be hard to tell. But the major fact remains that if you want everybody to play on the healthcare playing field--to use EHRs in all aspects of care--you're going to have to equip everybody the same way. - Janice

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