As I mentioned in my previous post on EHR Penalties and Meaningful Use Failure, I had a really good discussion with Stoltenberg Consulting about rural hospital EHR at HIMSS this year. While Stoltenberg no doubt works with hospital systems of every size, I could tell that they had a real affection for the rural hospital EHR challenge. Plus, it was great to be educated some more on the challenges rural hospitals face when it comes to meaningful use and EHR since I’ve been doing a lot more writing about it on my Hospital EMR and EHR website.
I collected a few observations from my chat that I think are worth talking about when it comes to the unique rural hospital EHR situation. One of those ideas is the challenge that rural hospitals have in providing EHR help desk support. It’s worth remembering that hospitals are 24/7 institutions that need 24/7 support in many cases. Now imagine trying to staff an EHR help desk for a small rural hospital. From what I’ve seen, most can barely have an IT support help desk available, let alone an EHR help desk. Stoltenberg Consulting wisely sees this as a great opportunity for EHR consults to provide this type of service to rural hospitals. If you spread the cost of a 24/7 EHR help desk across multiple hospitals, the costs start to make sense.
Another interesting observation was that most rural hospitals are mostly Medicare and Medicaid funded. I’m not an expert on the pay scales of rural America, but when you look at the costs of living in the rural areas you realize that they don’t need to make as much money to live. Plus, I imagine in some cases there just aren’t that many jobs available to them. If they aren’t making as much money, then they’re more likely to qualify for Medicare and Medicaid. Why does this matter?
The amount of Medicare a rural hospital has matters a lot since if they don’t show “meaningful use” of a “certified EHR” then they will incur the meaningful use penalties. It’s simple math to see that the more Medicare reimbursement you receive the larger the EHR penalty you’ll incur.
There’s something that doesn’t feel right about the rich hospitals who’ve likely implemented an EHR before the stimulus getting paid the EHR incentive money while rural hospitals who can barely afford to keep their doors open getting not only penalties, but large penalties because of their large Medicare reimbursement. It’s probably water under a bridge now, but I could see why Stoltenberg Consulting suggested that rural and community hospitals should have been given more time to show meaningful use of an EHR.
As I mentioned, I’m still learning about the rural hospital EHR space, but I found these points quite interesting. If you have a different view or have experience that differs, I’d love to hear about it in the comments. No doubt there are thousands of unique rural environments and I’d love to learn more about them and how they’re approaching EHR. Please share your experiences and thoughts in the comments.