Policymakers may have hoped for — even anticipated — a sprint toward meaningful use incentive payments, but it would appear that the program is slow getting out of the starting blocks.

The Obama administration orignally estimated it would pay out up to $2.8 billion during fiscal 2011, which ends Sept. 30. As of July 31, Medicare and Medicaid had combined to pay hospitals and eligible professionals $397 million under the meaningful use program, which was authorized by the 2009 stimulus law. Only 38 percent of that total — $149 million — is Medicare payments for providers that actually have met meaningful use standards. Under Medicaid, providers can attest that they've implemented or upgraded a certified electronic health record system to receive incentive funds.

About 1,700 hospitals had registered for the incentive program as of July 31. Attestation — when hospitals verify to the Centers for Medicare & Medicaid Services that they've met the criteria — opened in April and through July just 66 had received payments under Medicare.

The numbers don't come as a shock to vendors or provider groups that have suggested that meeting meaningful use criteria will not be easy.

An American Hospital Association survey last January showed that just 2 percent of hospitals could meet meaningful use requirements. Predictably, about 2 percent attested in the first half of 2011, notes Chantal Worzala, director of policy for the AHA.

"Stage 1 is a heavy lift, with very explicit requirements that take a lot of time and attention to make sure you're doing it all," Worzala says. Quality reporting, she notes, has been especially problematic. Data from H&HN's Most Wired Survey bear that out. For instance, CMS requires that hospitals record an up-to-date problem list of current and active diagnosis for 80 percent of patients. Roughly 70 percent of Most Wired hospitals have this capability, compared with 52 percent of all hospitals filling out the survey. The Most Wired data show similar challenges with other data collection criteria.

"Obviously, we'd like these dollars to flow more quickly, but we're not surprised at the pace," Worzala adds.

A CMS spokesman rejects the idea that the meaningful use program was attracting less interest than expected, saying that the agency "can't forecast actual results." He adds, "We recognize that providers can begin their attestation in 2012 and still receive the full incentive payment, and a number of them plan to wait until next year to attest. Although we're seeing the number of providers attesting increase month over month, we anticipate that the largest increase will be in 2012."

That's what software vendors expect, too, says Charlene Underwood, senior director, government and industry affairs, for Siemens, and chair of the Healthcare Information and Management Systems Society board. Although electronic health record adoption has risen sharply and hospitals are busy implementing their new systems, she says, many have taken their consultants' advice and decided to hold off until 2012 to attest.

"The consultants say, 'There's no advantage in being an early mover in 2011. You'll get just as much money if you wait until 2012. You'll waste less resources, because a lot of things will be nailed down by then,'" including the Stage 2 meaningful use rules, she notes.

But there's confusion about whether Stage 2 will be delayed from 2013 to 2014, as the AHA, the federal Health IT Policy Committee and others recommend. CMS officials have not commented on a potential delay.

Nevertheless, hospitals are "committed to showing meaningful use," Worzala says. "They're investing a lot of resources in doing it now, and we're going to be working with our federal partners to ensure that it's as smooth a journey as possible."

Early Adopters Outpace the Pack

Physicians and other eligible professionals have been a little faster off the mark than hospitals in attesting to meaningful use. From January through July, 75,000 EPs registered for the program. Among those who applied to the Medicare program, 1,078 received a total of $18.4 million. The 3,334 EPs who registered for Medicaid, which doesn't require attestation in the first year, pulled down $70.2 million.

The EPs who registered and attested first, however, tended to be those who were early adopters of electronic health records, says Robert Tennant, senior policy adviser to the Medical Group Management Association.

Tennant, who expects EP registrations to level off or even decline next year, says, "The criteria for meaningful use may be overly challenging for folks other than the highest-level practices." If the Stage 2 requirements are too stiff, "that may be a disincentive for groups to move ahead," he notes.

The bewildering profusion of certified EHR products — 900 of them at last count — and the uncertainty surrounding future Medicare cuts also may discourage some physicians, Tennant says. But the biggest problem is the criteria themselves. Such seemingly simple requirements as giving 50 percent of patients a clinical care summary and prescribing electronically for 40 percent of patients contain hidden pitfalls that many practices have found challenging.