Supplemental “Rural Hospital” REC Funding May Not Reach Most Rural Hospitals

The following guest post is provided by Louis Wenzlow at Rural Health IT, a collaboration between the Wisconsin Office of Rural Health and the Rural WI Health Cooperative (RWHC).  Louis is RWHC’s Director of Health Information Technology and the Chief Information Officer of the RWHC Information Technology Network. Learn more about this blog.

Yesterday I participated in the ONC conference call explaining the new small rural hospital Regional Extension Center (REC) supplemental funding opportunity.

According to the opportunity announcement, the supplemental funding is intended to provide “additional support for staffing and expertise to assist rural CAHs and Rural Hospitals with less than 50 beds in selecting and implementing meaningful electronic health record (EHR) systems.”

I have good news, bad news, good news, and bad news.

The good news is that my concern about the FOA’s “intent” requirement (“Funds can only be used to assist CAH and Rural Hospitals that the REC intended to serve in their original application”) has been allayed. An ONC representative indicated on yesterday’s call that “intent to serve” will be interpreted liberally.

My understanding of ONC’s position is that RECs should use their own discretion in determining whether they had the intent to serve (i.e. the intention does not need to be explicit in the original application.)

See my April 3rd post for more detail on this issue.

The bad news is that at the beginning of the call the ONC representative indicated that the funds should only be used for outpatient projects, with funding to be tied to primary care physician meaningful use attainment.

Am I the only one who found this bizarre? CAHs and small rural hospitals can only become meaningful users of EHRs by meeting the inpatient meaningful use requirements, yet REC funds specifically earmarked for them are not to be used for inpatient projects?

According to ONC’s initial description of how this would work, RECs would get an extra $12,000 per hospital (in addition to the $5,000 per physician they will already receive through the original REC program) for every CAH and small rural hospital in which they help prioritized primary care physicians achieve “eligible professional” meaningful use.

Not only does this methodology neglect the area (inpatient) where CAHs/rural hospitals need the most help, it ignores the fact that a large percentage of small rural hospitals (60% in Wisconsin) do not own primary care clinics and do not employ primary care physicians. Are all these CAHs and rural hospitals that do not fit into ONC’s primary care strategy to be excluded?

The good news is that toward the end of the call ONC softened its position to allow RECs to go ahead and propose to use the funding for inpatient meaningful use work. This is very welcome news, and I encourage all RECs to think about what is best for their rural hospitals in deciding how to use these “rural hospital” funds.

The bad news is that RECs throughout the country heard ONC’s overt message, which I would sum up as: Okay, RECs can help on the inpatient side if they really want to, but they don’t have to.

Because ONC does not require or even recommend for RECs to use the rural hospital supplemental funds to help rural hospitals achieve “hospital” (inpatient) meaningful use, my prediction is that many RECs may not go to the trouble of establishing inpatient technical assistance programs. Why not simply take the additional $s for work that has already been committed to with other funds? It seems inconsistent with the stated intent of the supplemental FOA, but the transcript of the call will show the ONC representative saying something to the effect of “no additional work needs to be done for this.”

Those of us who care about rural hospitals and communities need to roll up our sleeves.