I keep bouncing between cynicism and optimism on ARRA and the meaningful use rule. There are definitely a few problems with the proposed rule but I want to focus right now on how it will define a hospital-based eligible provider. I’m trying to be an optimist, but this portion of the rule really seems counter productive.
Many hospitals would like to help physician practices to adopt and achieve meaningful use of EHR systems. But we will need some clarity on the definition of a hospital-based EP under the proposed MU rule in order to move forward. As written, the rule will consider as outpatient hospital settings those settings that are owned by and integrated both operationally and financially into the entity that owns and operates the inpatient setting. CMS estimates that 12–13% of family practitioners would be considered hospital-based under the proposed definition of hospital-based EP, and therefore would not be eligible for the EHR incentive payments. This will disincentivize adoption for a large swath of providers and really makes little sense.
CDC recently announced this years NAMCS survey. Below are some excerpts from the Federal Register which point towards a logical definition of an eligible provider:
Ambulatory services are rendered in a wide variety of settings, including physician offices and hospital outpatient and emergency departments. The NAMCS target universe consists of all office visits made by ambulatory patients to non-Federal office-based physicians(excluding those in the specialties of anesthesiology, radiology, and pathology) who are engaged in direct patient care.
In 2006, physicians and mid-level providers (i.e., nurse practitioners, physician assistants, and nurse midwives) practicing in community health centers (CHCs) were added to the NAMCS sample, and these data will continue to be collected.
To complement NAMCS data, NCHS initiated the National Hospital Ambulatory Medical Care Survey in 1992 to provide data concerning patient visits to hospital outpatient and emergency departments.
These data were requested by the Office of the National Coordinator for Health Information Technology (ONC), Department of Health and Human Services, to measure progress toward goals for EMR adoption.
Obviously the same providers that are going to be excluded from receiving incentive payments are included in the survey used to measure adoption progress. For consistency, and to truly promote meaningful use, the definition of an EP needs to change. If a hospital system wants to provide a physicians’ EHR and no one is eligible for stimulus funds, then a hospital will make ambulatory EHR a much lower priority, and providers will be forced to go it alone.
It is not to late to do something about this situation. The comment period is open until March 15. Everyone interested in the incentive payment program should comment. If enough comments are submitted on this issue maybe CMS will make some reasonable changes (now many will say I’m much more a dreamer than an optimist) You can submit your comments AT THIS LINK HERE