Executive Reaction to the Stimulus

KLAS says: Providers are still stunned by the whiplash resulting from the unexpected and high-velocity changes of direction brought on by the American Recovery and Reinvestment Act (ARRA). The prospect of dramatic, new reimbursement guidelines, created right in the middle of the most impactful economic downturn in recent history, has stratified acute care provider organizations into four distinct groups. The most proactive group, about 30 percent, was in a batten-down-the-hatches mode as of January 2009, but has now turned on the rocket boosters to get EMRs beyond expected levels of “meaningful use” by 2011.

The ARRA's Immediate Impact

The day the ARRA passed, a large IDN reported an about-face, going from a plan for an extended delay of its EMR investment to preparing for board approval to move full steam ahead on aligning the organization for maximum reimbursement. “The ARRA will create a feeding frenzy for EMRs and will overburden vendors and consulting firms,” summarized the IDN's executive team. Getting first dibs on available resources was high on their list of priorities.This mentality correlates with the first of the following three distinct groups:

28 percent: Speeding up or changing direction. This group wants first pick of the best resources. There were sufficient incentives in the ARRA to warrant an acceleration of project plans or a change in the direction of those plans. The day before the passage of the ARRA, these organizations had plans for layoffs, delays in CIS rollouts, and a reduction in capital spending. Now, after the passage of the bill, hospital executives are meeting with their boards to fund ways to expand physician/clinician use of electronic tools in their IT efforts. Access to capital is the major hurdle.

43 percent: Ready to move, but with no immediate plans; anxiously monitoring rules and definitions. These hospitals are cautious, but poised. Hospital executives hope that the “meaningful use” bar is not set too high or the timelines too short, preferring a phased approach. Many are hoping that they have already bet on the right horse with their CIS IT investment, but are anxious to lock in new resources before they are gone, once clear requirements are in place.

29 percent: Strapped for capital or already done. These organizations will respondents form two groups:

• We're already there. These hospitals have a fully deployed CIS with deep adoption or ongoing plans to finish. They are not worried, as they believe they are on their way to meaningful use with currently progressing nurse and physician adoption.

• We're handcuffed. Due to present financial and organizational constraints, these hospitals feel they have no option besides continuing their present course and hoping for a miracle. These are most likely community hospitals with little or no access to capital; they are looking for creative ways to meet maximum reimbursement requirements.

Healthcare Informatics 2009 October;26(10):12