Congress will consider changing how hospitals are paid under the meaningful use rule, allowing each hospital in a multi-hospital campus to earn incentives.
Rep. Zack Space (D-Ohio) and Sen. Charles Schumer (D-N.Y.) have introduced bills that would allow hospitals in multi-campus organizations to apply separately for millions in incentives.
Under the Electronic Health Record Incentives for Multi-Campus Hospitals bill (H.R. 6072), introduced on July 30, and its matching Senate bill (S 3708), introduced on Aug. 5, health systems would be able choose whether to receive base payments for each campus and one per-discharge sum or one base payment for the entire organization with additional per-discharge amounts for each campus.
Under the meaningful use rule of the American Recovery and Reinvesment Act, the hospital EHR incentive payment formula incorporates both a $2 million base amount annually and a $200 per discharge amount for the 1,150th to 23,000th discharge for the entire hospital campus.
Hospital groups have expressed support for the proposed bills. They had expressed misgivings about the meaningful use rule, released on July 13, that would prevent them from earning millions of dollars in incentives by forcing multi-hospital campuses to be considered one hospital.
The American Hospital Association has argued that providing ncentives to only one hospital in a multi-hospital system would not accurately account for the implementation and training costs of EHRs across different institutions.
According to AHA Vice President Rick Pollack, the final rule would not pay hospitals accurately to reflect differences in clinical services provided at different sites.
Premier officials, meanwhile, say more than 50 hospital systems in the Premier group, representing more than 100 inpatient facilities, are affected by what they call a "methodological error" in the meaningful use rule.
One of the drafters of the rule, Tony Trenkle, director of the Office of E-Health Standards and Services at the Centers for Medicare and Medicaid Services, said CMS reviewed comments and met with interested stakeholders, including the two largest hospital associations – the AHA and the Federation of American Hospitals – to hear their concerns when the rule was proposed.
"Taking this input as well as the legislative language of the Recovery Act into account, we came to the conclusion in our final rule that we should define 'subsection (d) hospital' in alignment with how we have defined that term in other situations," Trenkle told a congressional panel.
Trenkle said "other situations" include the Medicare Disproportionate Share payment program, which considers multi-hospital campuses to be one hospital for reimbursement purposes.
CMS could face lawsuits if it does not stick with a uniform way of treating multi-campus hospital systems for reimbursement purposes across all programs, Trenkle said. It would take congressional action to allow CMS to deviate from considering multiple campuses as one hospital.
Both bills have been referred to Congressional committees for consideration. Congress returns from recess on Sept. 13.