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Study: Significant Meaningful Use Variations Exist Among Rural Providers

January 21, 2016
by Rajiv Leventhal
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Three-quarters of rural providers have attested to MU, though many are skipping program years

While rural hospitals and physicians have adopted health IT at the same, or greater, rates as their urban counterparts, meaningful use attestation varies considerably among rural providers, according to a study recently published in Health Affairs.

As a result, rural providers are more likely to skip a year of declaring that they have met meaningful use requirements, putting them at a financial disadvantage compared to urban providers, according to the study’s author—Dawn M. Heisey-Grove, a public health analyst at the Office of the National Coordinator for Health Information Technology (ONC).

The recent uptick in health IT adoption has led to fears that some providers and hospitals may be left behind as more advanced health IT use becomes required for healthcare delivery and payment reform, Heisey-Grove noted. She said, “Because health IT adoption and use can place significant technical and financial strain on hospitals and practices, the concern regarding a ‘digital divide’ is particularly prevalent for traditionally under resourced hospitals and providers, such as those in rural care settings.”  While prior national research has demonstrated that rural providers adopted health IT at the same, or greater, rates as did their urban counterparts, the research found that health IT use varied dramatically among rural providers.

The study found that, in 2013, more than eight in 10 (82 percent) of rural physicians had adopted an electronic health record (EHR) system, compared to 78 percent of urban physicians. Similar differences were observed for nurse practitioners and physician assistants, according to the 2013 National Electronic Health Records Survey, conducted by the National Center for Health Statistics. Among eligible providers registered with the incentive programs by the end of 2014, a higher proportion of rural providers (41.9 percent) were registered with the Medicaid incentive program compared to urban providers (31.9 percent). Overall, rural registered providers were more likely than their urban counterparts to have achieved meaningful use, according to the study, which drew upon 2014 Medicare attestation data. More specifically, the analysis looked at data from nearly 500,000 providers and hospitals.

Drilled down further, among registered hospitals, 97 percent of small rural hospitals with fewer than 100 beds had achieved meaningful use—a rate consistent with large hospitals (also 97 percent) with more than 400 beds. Critical access hospitals had slightly lower meaningful use achievement rates (92 percent). Meaningful use achievement was highest among rural podiatrists (91 percent) and optometrists (88 percent), and lowest among rural dentists (9.5 percent), advanced practice nurses (33 percent), and physician assistants (28 percent). Overall, about three-quarters (74 percent) of rural physicians had achieved meaningful use, the study found.

What’s more, rural healthcare providers and hospitals were less likely to attest to all subsequent years of meaningful use, when compared to those in urban areas. Thirty-eight percent of rural Medicare-registered providers who first achieved meaningful use between 2011 and 2013 skipped at least one subsequent year between 2012 and 2014, compared to 35 percent of urban Medicare-registered providers who similarly skipped at least one year. Critical access hospitals and small rural hospitals had the highest rates of skipping at least one year (16 percent and 13 percent, respectively) among hospitals that first achieved meaningful use between 2011 and 2013.

According to Heisey-Grove, “Although initial health IT adoption and meaningful use achievement was higher among rural providers and hospitals compared to their urban counterparts, these populations were less likely to return in subsequent years of the incentive program. A survey conducted by the Centers for Medicare and Medicaid Services found that incentive program attrition among physicians could be ascribed to a variety of factors including retirement, confusion about program requirements or deadlines, and difficulty meeting program requirements.”

The research further found that technical assistance from a Regional Extension Center (REC) was strongly associated with meaningful use achievement among rural providers. Indeed, funding from ONC for Regional Extension Center assistance was primarily focused on initial Stage 1 meaningful use achievement, and the lack of similarly funded assistance for ongoing meaningful use achievement may be one reason rural providers were less likely to return for subsequent years of attestation, said Heisey-Grove.


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