GAO report finds EHR digital divide

A report from a federal watchdog gives further evidence of a digital divide between large and urban hospitals on one side and small and rural facilities on the other.

Under the federal electronic health-record (EHR) system incentive program, hospitals where at least 10% of patients are covered by Medicaid are eligible for payments through Medicaid for adopting a certified EHR. The Government Accountability Office (GAO), in a report reviewing the 2011 activities of the Medicaid EHR incentive program, found that 41% of eligible urban hospitals received EHR incentive payments. In comparison, 35.8% of eligible rural hospitals did.

Disparities were found based on hospitals' size, too. Nearly half (49.8%) of eligible large hospitals (176 or more beds) received Medicaid EHR payments, compared with 42.9% of eligible midsize hospitals (41 to 175 beds) and 24.9% of eligible small hospitals (40 beds or fewer). Among eligible critical-access hospitals—facilities with 25 or fewer beds—26.6% received payments.

Hospitals in the South led those in all other regions in Medicaid EHR incentive payments. More than 4 in 10 hospitals (46%) receiving payments under the Medicaid program were in the South. The Northeast had the smallest share of recipients, at 15%.

Payments for hospitals ranged from $7,528 to $7.2 million.

The CMS, in its monthly updates, also tracks EHR incentive payments. The Office of the National Coordinator for Health Information Technology also recently made available a map of EHR incentive payments.

Participation rates for the Medicaid incentive payment program were higher than those for the counterpart Medicare EHR incentive payment program, according to the GAO. In 2011, 1,934 hospitals were paid EHR incentives under Medicaid, compared with just 761 hospitals paid under Medicare. Payments to hospitals totaled $1.7 billion through the Medicaid portion of the program compared with $1.3 billion through Medicare. Neither outcome was particularly surprising, given the Medicaid program's lower technology threshold. Under Medicaid, to be paid, providers in the first year merely needed to adopt, implement or upgrade a certified EHR; under Medicare, providers had to use a certified system to meet the more strenuous meaningful-use criteria.)

Also, some state Medicaid program got a five-month jump start in 2011. First payments under state-administered Medicaid programs started going out in some states in January 2011, while the federally run Medicare program didn't make its first payment until that May.


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