Congress is considering taking action on an application of the meaningful use rule in healthcare reform efforts that hospitals say will cost them millions of dollars in incentives.
According to the American Recovery and Reinvestment Act of 2009, each hospital in a multi-hospital system is considered part of one hospital for reimbursement purposes.
Rep. Zack Space (D-Ohio) has introduced the Electronic Health Record Incentives for Multi-Campus Hospitals (H. R. 6072), which would allow each hospital in a multi-campus organization to qualify separately for meaningful use incentives. Sen. Charles Schumer (D-N.Y.) has introduced a matching Senate bill (S. 3708). Both bills have been referred to committees for consideration, but little action will likely be taken until Congress returns from recess on Sept. 13.
According to the final meaningful use rule, the hospital EHR incentive payment formula incorporates both a $2 million base amount annually and a $200-per-discharge amount for each discharge between 1,150 and 23,000.
The new bill would allow health systems to choose whether they want 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.
American Hospital Association Vice President Rick Pollack applauded the bills.
“Providing these payments to only one hospital in a multi-hospital system would not accurately account for the implementation and training costs of EHRs across different institutions, nor would it accurately reflect differences in clinical services provided at different sites,” he said.
Officials with the North Carolina-based Premier healthcare alliance said more than 50 Premier hospital systems, representing more than 100 inpatient facilities, would be affected by what they called a “methodological error” in the meaningful use rule.
Tony Trenkle. director of the Office of E-Health Standards and Services at the Centers for Medicare and Medicaid Services, said CMS has reviewed comments and met with interested stakeholders, including the two largest hospital associations – the AHA and the Federation of American Hospitals.
“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,” Tenkle told a Congressional panel.
Trenkle said “other situations” include the Medicare Disproportionate Share, or DSH, payment program.
Because the government could be sued for treating hospitals differently – as in the DSH program and EHR incentives program – Trenkle said Congress would need to change how hospitals are defined for reimbursement purposes.