Long Term Care Missing Out on EMR Stimulus Money

A short while back I posted about my interest in the long term care EMR market. From that post I’ve started a number of really interesting discussions. It’s been quite enlightening and fun for me to learn about the long term care market since I was previously unfamiliar with the details.

One thing that kind of strikes me about the long term care EMR market is that it doesn’t seem to me that their going to be getting any help from the EMR stimulus money that everyone’s talking about. At least if my assumptions are correct. Since the EMR stimulus money is going to be paid out per provider, it seems like most long term care facilities are going to not be eligible since they’re nurse run and not provider (doctor) run. Someone please correct me if I’m wrong in this assumption.

Certainly, there is the possibility that ONC and HHS might make some of the other ARRA money they received available as grants to the long term care market for purchase of an EMR. However, that is still yet to be seen.

This is rather unfortunate for long term care facilities. I think we can safely say that healthcare’s use of technology is behind almost every other industry. Low EMR adoption rates are evidence of this fact. With that said, from what I’ve read and seen long term care facilities are even farther behind on their adoption of technology. Sadly, if long term care facilities aren’t getting any EMR stimulus money, then it’s possible they will lag behind even farther in adoption of healthcare IT.

Are there any other specialty areas or healthcare segments that are going to miss out on the EMR stimulus money as well?

UPDATE: One reader of my site sent the following additional information and questions: “Nursing Homes overall are considered as a provider. The Nursing Home is issued a Provider Number (not the administrator) and is used for billing purposes and reimbursement purposes. When the Feds say that providers are going to get stimulus money through grants does this mean that LTC facilities are excluded? Who knows at this time. What is the difference between an individual Provider and a Facility as a Provider? I can’t answer this. Only the Feds know at this time.”

I’ve talked to some other Long Term Care EMR companies and they have the same questions. Looks like the problem is that we just don’t know. Although, I’d argue that it’s likely that the Feds don’t know yet either.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Hey Bill,
    I’ll admit to a bit of weakness in the dentistry area. That said, the only thing I’ve read about dentists is on the Medicaid side and only in rural areas to qualify. I’d just be interested to know how many dentists have 30% of their practice covered by Medicaid Does Medicare even cover dentistry?

    The other thing that I have a hard time reconciling is the meaningful use matrix and how that applies to dentists. Some requirements apply, but some don’t make sense for dentistry right?

  • The relevant ARRA legislative language defines “eligible professional” as an individual who meets the definition of a “physician” in Section 1861(r) of the Social Security Act (http://www.ssa.gov/OP_Home/ssact/title18/1861.htm). That definition includes in 1861(r)(2) “a doctor of dental surgery or of dental medicine who is legally authorized to practice dentistry by the State in which he performs such function and who is acting within the scope of his license when he performs such functions.”

    I am not an expert in dentistry, so the extent to which dentists participate in Medicare in general is unknown to me, but the amount of the incentives a provider receives is tied to participation.

    For the Medicare version of the “for provider” incentives program, an eligible provider must not be hospital-based, whereas “hospital-based” is defined as the primary site of service, and not by employment or financial relationships with a hospital. Any eligible provider (so, any “physician”) who meets this criteria must demonstrate meaningful use, or face overall Medicare reimbursement reductions in 2015 and beyond. So, a large number of non-primary care physicians (i.e., specialists) are in serious trouble.

    The fact that the HIT Policy Committee focused on only primary care physicians in their meaningful use matrix is the Committee’s only failure — but it’s a massive failure. The Recovery Act itself only mentions the words “primary care physician” five times, and none of these occassions are within the section that authorizes the incentives program.

  • Mike,
    I was thinking about this subject myself. I have a friend that has a pediatric orthopedic practice whose had an EMR for a number of years. In passing I asked him if he was going to try and get the stimulus money. He hadn’t even heard about it. That aside, I started asking him some of the meaningful use criteria like ePrescribing and he’s like I only write a couple prescriptions a week. I’m going to do a post on this later. It’s definitely going to be interesting to see how they measure meaningful use for specialists for which the MU requirements don’t match very well.

  • John- Thank you for responding. Excellent blog by the way.

    What will be interesting to me personally is seeing how ONC (and ultimately CMS) deals with those specialties that have sizeable Medicare case loads and also have a large number of their specialists outside of hospital settings.

    Oncology is one example, but the basic workflow of a general oncologist (as opposed to an oncology subspecialist, like a radiation oncologist) is not entirely unlike a PCP.

    Diagnostic radiology might be the most drastic and fitting example in that radiologists’ workflows do not resemble primary care in the least, and the majority of diagnostic radiologists work outside of hospital settings, whereby “hospital-based” is defined by the site of service (the read). Also, most patients who receive CT, MRI, PET, or other imaging procedures for cancer, heart disease, or neurological disorders are generally elderly (i.e., many Medicare patients).

    Another fun example that I am just tossing out there as food for thought are chiropractors, the qualified of whom actually do participate in Medicare for treating subluxation of the spine. Chiropractors fall under the SSA definition of a physician as well, believe it or not, and almost all are in private practice.

  • Hey Mike,
    Thanks for the kind words. I love to respond. The interaction with readers is probably my favorite part of blogging. Glad you like my site.

    We could talk about this for a long time I think and not have any idea what ONC/CMS will actually do.

    However, let’s also consider the penalties. If they don’t provide a way for these specialties to qualify for the stimulus will they exclude them from receiving the penalties? Imagine the management of that reimbursement.

  • John- I work for a physician association, and I can tell you that one of the things we have always requested, both formally and behind the scenes, is a possible specialty-wide exemption from the disincentives if we are neglected by the MU criteria. A careful read of ARRA indicates that HHS technically has the authority to exempt eligible providers on an individual basis, but it is intended by Congress to be for those in rural areas without requisite technology access (broadband, etc.).

    ONC told us earlier this summer that CMS is considering exemptions as a possibility, but the “tagging” of specific criteria to certain specialties, then having these physicians report through attestation or existing national registries, would be more likely. If you look at the various House and Senate versions of the health care reform legislation currently being batted around on the Hill, they all include a provision that would confirm that CMS has the authority merge aspects of the PQRI and meaningful use programs. Just a guess, but this tells me something about what CMS is thinking for implementation/reporting.

    If they do “tag” certain criteria to relevant specialties, with the direct input and endorsement of the national associations representing those specialties, that would be a huge plus.

  • Hi,

    I think you are doing an excellent job, one of my colleagues and I have been tempted to contact you to suggest some very interesting topics to speak about. We work with an IT management firm and one of the line of business is HIT and we have met with over 125 different doctors over the past 6 months and boy I don’t even know where to start. I must some have surprised us with the initiative that they have taken but there are some that we asked HOW ARE THEY EVEN ALLOWED TO PRACTICE..

    Anyway keep up the good work… Do you write for other companies?????


    Patrick C O’Connell

  • Hi Patrick,
    Thanks for the kind words. It is quite amazing the stories that are out there. Not to mention the broad differences that you find.

    If you have some interesting stories you’d like told, I’d welcome you as a guest blogger. Just drop me a note on my contact us page: https://www.healthcareittoday.com/contact-us/

    I don’t write for other companies. I’ve considered doing it for a couple, but usually haven’t found the time to compensation ratio to work out yet. So, for now I stick to the occasional EHR speaking gig: https://www.healthcareittoday.com/emr-and-hipaa-speaking/

  • i am chair of a long term hospital that is doctor run and not nurse run and we exploring an emr system and from the talk i have had with medicare we are not included in the stimulus money for setting up such a system and the accute care hospital has epic which does not have a long term care software package. willette lehew

  • Hi John,

    Is this still the case? Long term care still does not benefit from any EMR incentive program?

    Do you have any contacts or know of any SME about this?

  • Hi Mark,
    I’ve seen overtures about trying to somehow get long term care access to the EHR stimulus money, but I can’t recall ever seeing some final rule that would make it possible for long term care. Sorry.

    You might talk to some of the top Long Term Care EHR software vendors since no doubt they’re tracking it much closer than I am.

Click here to post a comment