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Some Rural Hospitals Lack Health IT Infrastructure for CMS PIP

In its recently released Rural Report, the American Hospital Association cautions that some rural hospitals lack the health IT infrastructure required to meet the CMS Promoting Interoperability Program (PIP) requirement.

Rural Hospital

Source: Getty Images

By Fred Donovan

- In its recently released Rural Report, the American Hospital Association (AHA) cautions that some rural hospitals lack the health IT infrastructure required to meet the CMS Promoting Interoperability Program (PIP), formerly called the EHR Incentive Program.

Rural hospitals must meet the same regulatory requirements as urban hospitals, which requires investments in system upgrades and hiring and training staff to use the new technology. Yet, some of these hospitals don’t have the resources to expand broadband networks and upgrade systems or the need for the additional functionality, the AHA report related.

“Lack of affordable, adequate broadband infrastructure impedes routine health care operations (such as widespread use of EHRs and imaging tools) and limits their availability,” the reported observed. 

The association stressed that rural hospitals are “committed to improved care through use of HIT in order to meet past and current regulatory requirements,” but they need some leeway with CMS rules in order to comply without forcing them to close.

“While CMS recently provided needed flexibility in the Promoting Interoperability Program, concerns remain that the requirements and technology costs, particularly related to the 2015 edition certified EHR technology, are beyond the reach of some rural hospitals,” the report related.

AHA cited a GAO report that found 64 rural hospitals closed from 2013 through 2017, more than twice the number of rural hospitals that closed in the previous five years. “Rural hospitals that closed typically had negative margins that made it difficult to cover their fixed costs,” GAO observed.

The hospital association also pointed to a study by the North Carolina Rural Health Research Program that identified 95 US rural hospitals that had closed between 2010 and December 2018.

Other factors forcing rural hospital closures include low patient volumes, heavy reliance on public payer programs, geographic isolation, and a shift from inpatient to outpatient care.

“Rural hospitals are not just access points for care, they are cornerstones of care for the communities they serve,” said AHA President and CEO Rick Pollack. “In spite of their unique challenges, providing access to quality care where and when their patients need it will always be the goal of rural hospitals.”

Overall, the AHA said it is working to advance policy priorities across several key areas for rural health:

  • Updates to Medicare and Medicaid payment rates to cover the cost of care
  • New models of care that boost financial predictability and incorporate rural providers in the move to value-based care
  • Regulatory respite from outdated and onerous requirements that fail to improve patient care
  • Greater access to broadband and telehealth
  • Assurances that health IT costs and compliance requirements are addressed to ease the strain on rural hospitals
  • Workforce programs focused on rural areas hardest hit by provider shortages
  • Prescription drug price concerns, such as high drug costs and challenges to the Section 340B drug discount program.

Created in 1992, the Section 340B drug discount program requires drug companies to participate in Medicaid to sell drugs at discounted prices to healthcare organizations that care for significant numbers of uninsured and low-income patients.

Among these organizations are community health centers, children’s hospitals, hemophilia treatment centers, critical access hospitals, sole community hospitals, rural referral centers, and public and nonprofit disproportionate share hospitals that serve low-income and indigent populations.

“Although rural hospitals have long faced unique circumstances that can complicate health improvement efforts, more recent and emergent challenges are exacerbating their financial instability — and by extension, the economic health of their communities. Individually, these are complex, multifaceted challenges. Taken together, they are immense, requiring policymakers, stakeholders and communities to work together, innovate and embrace value-based approaches to improving health in rural communities,” the AHA report observed.

“The federal government must play a principal role by updating policies and investing new resources in rural communities,” it concluded.


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