More than two-thirds of the hospitals that received Medicare EHR incentive payments for 2011 are in urban areas, according to a new GAO report, which slices and dices who received how much and when and where.

Why? Because the HITECH ACT requires the GAO to report, among other things, the impact of its provisions on adoption of EHRs by providers.

In April 2012 GAO reported on CMS’s efforts to oversee the Medicare EHR program during its first year as well as challenges encountered by providers and strategies they used to participate in the program. At that time, GAO recommended that CMS take steps to enhance its processes to verify that providers met the requirements to receive incentive payments. On behalf of CMS, the Department of Health and Human Services agreed with most of our recommendations, and audits have begun.

In this most recent report, the GAO focuses on the characteristics of the hospitals and eligible professionals who received incentive payments.

The incentive program awarded 761 hospitals and 56,585 professionals a total of approximately $2.3 billion for 2011– $1.3 billion to hospitals and $1 billion to eligible professionals. The 761 hospitals represent 16 percent of the estimated 4,855 eligible hospitals. The amount awarded to hospitals ranged from $22,300 to $4.4 million. The median payment was $1.7 million.

Among hospitals awarded an incentive payment for 2011, GAO found:

• About 61 percent of hospitals accounted for about 80 percent of the total amount of incentive payments awarded to hospitals.
• The largest proportion (44 percent) are located in the South, and the lowest proportion (12 percent) were located in the Northeast.
• About two-thirds (67 percent) were in urban areas.
• More than four-fifths (86 percent) were acute care hospitals.
• Almost half (46 percent) were in the top third of hospitals in terms of number of beds.

Hospitals with certain characteristics were more likely to have been awarded an incentive payment. For example, acute care hospitals were more than two times more likely than critical access hospitals to have been awarded an incentive payment. Hospitals in the top third in terms of numbers of beds were 2.4 times more likely than hospitals in the bottom third to have been awarded an incentive payment. Further, nonprofit and for-profit hospitals were 1.1 and 1.5 times more likely than government-owned hospitals, respectively, to have been awarded an incentive payment.

The 56,585 professionals who were awarded a Medicare EHR incentive payment for 2011 represented about 9 percent of the estimated 600,172 professionals eligible for the program, and were awarded a total of about $967 million in incentive payments. Among professionals awarded an incentive payment for 2011,

GAO found:

• The largest proportion (32 percent) were located in the South, and the lowest proportion (17 percent) were located in the West.
• A significant majority (89 percent) were in urban areas.
• Half (50 percent) were specialty practice physicians and over one-third (38 percent) were general practice physicians.
• Nearly three-quarters (71 percent) did not previously participate in CMS’s incentive program for electronic prescribing.
• About half were in the top third in terms of 2010 Medicare Part B charges (46 percent) and 2010 Medicare Part B patient encounters (51 percent).
• Professionals with certain characteristics were more likely to have been awarded a Medicare EHR incentive payment for 2011.

For example, general practice physicians were 1.8 times more likely than specialty practice physicians to have been awarded an incentive payment. Professionals who had previously participated in CMS’s electronic prescribing program were almost four times more likely to have been awarded an incentive payment than those who had not participated in the electronic prescribing program, and professionals who had signed an agreement to receive technical assistance from a regional extension center were more than twice as likely to have been awarded an incentive payment.

Professionals in the top third in terms of 2010 Medicare Part B charges or number of 2010 Medicare Part B encounters were more than three times more likely to have been awarded an incentive payment compared to those in the bottom third for charges or number of encounters.