Meaningful Use May Unintentionally Increase Care Disparities

I read with great interest this week my colleague Ron Shinkman's thought-provoking commentary about how the 25 states that have refused to expand Medicaid eligibility pursuant to the Affordable Care Act and rejected billions of federal dollars could ultimately degrade the quality of their patients' care. Shinkman, editor of FierceHealthFinance, noted that hospitals in at least one of these states have already started laying off staff, which often impacts the quality of care provided.

It's a new twist on the "have vs. have not" debate. The rich get richer, the poor get poorer.

I worry that the Meaningful Use incentive program is creating a similar dichotomy. Attaining Meaningful Use is much more elusive for hospitals with fewer resources, further widening the "digital divide." Research published this summer found Meaningful Use progress "uneven," with smaller, critical access hospitals struggling, a finding that was corroborated by a recent GAO study. What's more, the Centers for Medicare & Medicaid Services recently reported that while 70 percent of community health centers--which typically treat lower income patients who either are uninsured or Medicaid beneficiaries--have adopted some sort of electronic health record system, only a scant 9 percent have met the Meaningful Use requirements, despite support from the Office of the National Coordinator for Health IT's regional extension centers.