non-profit hospitals

CO to create country's largest telehealth network

Anne Zieger — Mon, 25 Aug 2008 00:46:13 -0400

Colorado should soon play host to the largest telehealth network in the country, courtesy of a $4.6 million grant from the Federal Communications Commission. The Colorado Hospital Association, which is getting the grant, will develop the network over a three year period. The initial money will be supplemented by an additional $9.8 million from a grant managed by the Colorado Behavioral Healthcare Council.

The FCC is covering 85 percent of the cost of building out the network, including design and engineering, hardware and installation for public and not-for-profit hospitals and clinics. To date, 72 hospitals, 118 clinics and 184 mental health centers have come on board to participate in the network. Each will get 15 percent in matching funds for participating in the telehealth network.

To learn more about the network:
- read this Healthcare IT News article

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Non-profits wondering how IRS feels about RHIOs

Mon, 19 May 2008 06:59:59 -0400

As most readers know, it took what felt like an eternity for the IRS just to come out with it and say how it felt about non-profit hospitals' plans to make EMR donations to physicians. So complex and mighty is the IRS that even its "yes" doesn't appease everybody--so its memorandum on the subject, while helpful, hasn't exactly led to a rush of free or low-cost EMR rollouts. Still, it has gotten the ball rolling.

Now, it's looking like yet another promising, if slow-moving and costly, movement could get caught up in the IRS gears. If you read the entire Modern Healthcare story excerpted below, which talks about how not-for-profits are finally starting to give away EMRs to doctors, you'll see the problem. In a small aside, the story notes that the groups behind some RHIOs have begun to ask the IRS for guidance on what they can and cannot do to build their networks.

Their worries seem more than justified. After all, if they want to put an effective health data sharing organization in place, the non-profits getting involved in RHIOs may have to give away or subsidize a few technologies. Depending on how their network is configured, it may be enough to supply EMRs and follow the existing rules--but maybe they'll need to supply additional gear and software as well. At that point, arguably, the water gets murky again.

With any luck, this issue will be addressed faster than the EMR issue was. I hold out some hope that it will, given that IRS officials (who are, after all, human) may simply feel that they've worked some of the key issues out for themselves already. But it remains to be seen.

Folks, here's hoping that one of the world's most ponderously slow agencies decides to go into overdrive this time. With many RHIOs struggling to stay afloat financially, an indefinite series of delays could be deadly. - Anne

Non-profit hospitals offering EMRs to MDs, but cautiously

Mon, 19 May 2008 06:59:57 -0400

It's been about a year since the IRS officially declared that under the right circumstances, it was perfectly fine with not-for-profit hospitals and systems giving EMRs to affiliated physicians. Since that time, the not-for-profits have gradually begun to take advantage of the ruling, though many have spent a long time feeling things out before they moved ahead.

That may be, in part, because like all IRS gifts, the memo came with obligations, too. For example, the agency's memo requires that hospitals be able to access the records the physicians create with the technology the hospital donated--at least within HIPAA guidelines and state privacy rules. Another rule is that the EMRs must be made available to all physicians with staff privileges at a given facility, and that the subsidy must be the same for everyone or vary by criteria related to community needs.

Over the past year, not-for-profits have worked cautiously, careful to set up EMRs that comply with these and other conditions, as well as conforming with HHS rules on this subject. For example, while planning the rollout of its $8.3 million rollout of GE's Centricity system, Falls Church, Va.-based Inova Health System has stayed in touch with the IRS to make sure they're in compliance. Inova is offering the 3,000 community physicians on staff with its hospitals a deeply discounted per-physician fee for assessment, planning, training, implementation and licensing of the EMR.

To learn more about this trend, including several hospital and health system examples:
- read this Modern Healthcare article (reg. req.)

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S&P to monitor non-profit hospital IT spending

Mon, 19 May 2008 06:59:56 -0400

Over the next few years, credit rating firm Standard & Poor's plans to take a much closer look at the extent to which not-for-profit hospitals keep up with their peers in making technology investments while keeping finances otherwise in order. In fact, investment in advanced medical technology will be a key factor differentiating those with good and poor credit ratings, the firm said last week.

This isn't a novel approach. As we reported last year, credit rating agencies, banks, bond insurers and other financial institutions already take a look at the soundness of a healthcare organization's IT plans at many points in their analytical process, including when they consider investing, when they're underwriting bond issues or when they're rating the soundness of these bonds. But anytime a powerhouse like S&P makes noises on a subject, people listen.

In S&P's case, the firm says it's going to drill down into whether a hospital's medical technology investments made sense and what impact they had. However, the fact that S&P feels it necessary to make formal comments on this issue suggests that analysts may base more of their assessment on IT strategy, investments and deployments than they had in the past.

To learn more about S&P's criteria:
- read this Modern Healthcare article (reg. req.)

ALSO: How can one healthcare organization compare its level of IT investment to another? One not-for-profit group has been gathering IT investment data in an effort to make accurate comparisons possible. Article

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Legal or not, EMR donations still chancy

Sun, 13 May 2007 20:01:39 -0400

It's always nice to be out from under the white-hot scrutiny of the IRS, so it's great that the agency has joined HHS in making physician EMR donations safe for non-profit hospitals--but are such donations smart strategy? Maybe, maybe not.

To establish a collaborative EMR implementation between a hospital and its hundreds (or thousands) of affiliated practices, I believe the following would be minimum requirements:

The hospital has a close relationship with core admitters (perhaps in a small market where competition isn't as brutal).
Key affiliated practices are IT-friendly, yet haven't adopted and committed to an EMR of their own.
The hospital has enough IT staffers to offer free support to physicians as the donated EMR falls into place.
Both the medical practices and hospitals are prepared to absorb major changes in their work flow, and resolve conflicts patiently over a year or more.
The hospital finds a vendor which is particularly skilled at managing implementation across differing technical environments, including varied operating systems and access devices (including multiple handheld/wireless devices).
Physicians are comfortable with all of these changes, and aren't prone to shifting admissions elsewhere to avoid engaging with new technologies.

Even in this more-or-less ideal situation, some critical issues remain. For example, I still wonder whether physicians will actually use externally-donated EMRs for the bulk of their work, even if they're delivered with a bouquet of flowers. I also wonder whether a hospital can and should build a key part of their long-term IT strategy around what physicians outside of their organizations will agree to adopt. After all, tailoring your development strategy to meet the needs of practices you neither own nor manage is a significant risk.

What I'm getting at here, I guess, is that the IRS may have removed an important obstacle to handing out an EMR system--but they haven't made rollouts, integration or achieving strong user adoption any easier. That problem, for better or worse, is still in your hands. - Anne

IRS gives physician EMR donations the OK

Sun, 13 May 2007 20:01:38 -0400

Non-profit hospitals across the U.S. got a gift this week from the IRS, which ruled once and for all they can safely donate EMR systems and related support services to affiliated doctors. Many of these hospitals have looked at giving doctors with staff privileges EMR systems, rather than waiting until the physicians were ready to invest themselves. However, until last week it wasn't clear whether the IRS saw such donations as providing "private benefit," something that could endanger a hospital's tax-exempt status. HHS already came forward last year with rules that explicitly allowed for such donations, but the IRS has lagged on the issue.

The new IRS ruling notes that when hospitals make such a donation, they must follow the related HHS rules, too; that hospitals must have access to all records created by the physicians whenever possible; and that all medical staff members have the same access to the same donation levels (or if donations differ, that hospitals must justify the differences in terms of community needs).

To learn more about the ruling:
- read this Health Data Management item
- read the IRS ruling (.pdf)

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Reaching doctor data poses EMR challenge

Mon, 15 Jan 2007 19:01:37 -0500

As if rolling out EMRs wasn't challenging enough, ComputerWorld reminds us that in order for EMRs to be useful tools for both hospitals and doctors, hospitals must be able to access doctors' records. Roughly 70 percent of the care patients receive will be administered outside the hospital setting. "If hospitals are automated to the max and their referring physicians are still using paper, all they have is a fairly expensive 30 percent solution," explains John Morrissey, director of knowledge at the National Alliance for Health Information Technology. This poses a particular challenge for non-profit hospitals. For-profit hospitals can simply give the correct software to their physicians, but not-for-profits can only do so if they can prove that the software was given to doctors for "public benefit." Understandably, this can make not-for-profits nervous, since they want to avoid any unnecessary attention from the IRS. Several months ago the AHA requested guidance from the IRS about whether not-for-profit hospitals can provide discounted software to physicians and remain tax-exempt. Hospitals are still awaiting a response.

For more on EMRs:
- read this ComputerWorld article

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HHS, IRS rules on EMR donations clash

Sun, 12 Nov 2006 19:01:38 -0500

In some cases, giving a physician practice software, hardware and IT support may be the only way to get them on board with hospital EMR efforts. But despite new HHS rules allowing the giveaways, non-profits may not be able to do so. In August, the HHS Office of the Inspector General issued guidelines specifically exempting such donations from anti-kickback and Stark law rules. But then the IRS got into the act. While the IRS hasn't taken an official position on technology donations to physician practices, they're raised a warning flag suggesting that such donations may be prohibited under rules for non-profit status. Under IRS rules, non-profit hospitals may not make donations that don't benefit the public. The issue, which is still being reviewed by the IRS, is whether such donations create private or public benefit. To cover themselves, non-profit hospitals may be forced to seek what is known as a "private letter" ruling, which spells out the IRS's position on their particular situation.

For more information on this issue:
- read this iHealthbeat.com item
- read this American Medical News article (sub. req.)

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