Proposed new rules for long-term care released by the Centers for Medicare & Medicaid earlier this month could spur an uptake of EHRs by nursing homes across the country.

If that uptake occurs, it could be the missing link to making the health system digitally whole. The long-term care sector was left out of the government's meaningful use program, which, through the HITECH Act, dangled billions of dollars in incentives for EHR uptake in front of medical practices, hospitals and health systems – along with the prospect of penalties further down the road.

More than 15,000 long-term, post-acute care facilities – large and small, nonaffiliated and networked – provide care for about 1.5 million Medicare and Medicaid patients across the country.

The proposed CMS rules, detailed in 403 pages, go broad and deep, focusing on improving the quality of care for these beneficiaries. They also call for better oversight. There is no mandate for using EHRs, no incentives for adopting EHRs and no penalty for sticking to manual ways of doing business.

[See also: Long-term care providers use IT to help keep patients safe.]

However, the proposed rule would require nursing home and long-term care facilities to send patient care summaries to the nursing facility receiving the patient in the event of a transfer. It would not require the summary to be in digital form.

While the new rules would not require EHRs, the language does urge their adoption and use.

"We encourage facilities to explore how the use of certified health IT can support their efforts to electronically develop and share standardized discharge summaries," CMS writes in its proposed rule.

[See also: Nursing homes get help with HIE.]

Some post-acute care insiders view the new requirement as an opening to ask for help on the digital front.

Majd Alwan, senior vice president of technology at LeadingAge and executive director of its Center for Aging Services Technologies, recognizes that electronic transmission and the adoption of an electronic medical record system is not a mandate under the CMS proposed rule.

"But, it is generally going to drive more and more reliance on these tools and will put additional market pressures on those smaller and rural providers," he told Healthcare IT News.

Alwan said LeadingAge, an association of 6,000 not-for-profit organizations, would advocate for "measures that would level the playing field a little bit more for those providers."

He said LeadingAge would also develop free tools and resources that help them better understand the value of digital tools that help them select commercial products. LeadingAge also plans to advocate so that the scope of work for Federally-funded Regional Extension Centers that were set up by the government under the HITECH Act to help providers select and adopt EHRs, is expanded to cover long-term, post-acute care providers.

The organization would also advocate for financial incentives, whether it's direct financial incentives or incentives tying payment to quality.
 
For smaller providers, with few resources, he said, Leading Age would be looking for loan programs coupled with incentive programs tied to quality if they implement.

"We will more proactively advocate for, No. 1, incentives and more technical assistance  either direct financial incentives or incentives payments tied to quality as well as grants and loans coupled with technical assistance to the smaller, rural unaffiliated providers who do not have electronic health records, and do not have the resources to implement them."

"No. 2, we will continue to advocate, as we have been, with the Office of the National Coordinator, to ensure that there are sufficient opportunities for long-term and post-acute care providers to participate in the National Health Information Exchange efforts and other national health IT initiatives  that they're not sort of unintentionally excluded or sidelined."

[See also: CORHIO sees success with long-term and post-acute care.]

"What we're looking for is more engagement in health information exchange for those who have electronic health records because we know their level of participation  even among those who have the tools  is, frankly, quite low."

Whatever strategy LeadingAge takes in its advocacy, Alwan said, "you want to make sure that this rule does not inadvertently increase the digital gap between acute care facilities that receive the incentive on the one hand and the long-term, post-acute care facilities on the other."

He also cautions against increasing the gap between the rural, smaller, non-affiliated providers versus the larger, networked providers that already have implemented these technologies.

Based on a number of state surveys he's seen, his educated guess is that 40 to 45 percent of nursing homes use an EHR today. And, a LeadingAge survey of 150 of the organization's largest member providers, shows the number of long-term care facilities employing an EHR is at 75-76 percent.