HHS Expands Health IT Regional Extension Centers' Mission

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Touting the success of the health IT regional extension centers (RECs), the Office of the National Coordinator of Health IT said in a new report to Congress that the RECs are uniquely positioned to aid in care delivery transformation "because health IT is an integral component to healthcare reform."

Specifically, the report said, "RECs are well positioned to continue to assist providers with the next stages of Meaningful Use (e.g., Stages 2 and 3) and further develop and implement other core competencies such as privacy and security assessments and electronic health information exchange."

In addition, ONC stated, RECs will continue to work with the Centers for Medicare and Medicaid Services (CMS) on priority projects such as the Comprehensive Patient Care (CPC) Initiative and accountable care organization (ACO) programs.

The CPC Initiative is a multi-payer initiative designed to foster collaboration between public and private health care payers to strengthen primary care. Medicare is working with commercial and state Medicaid plans to offer bonuses to primary care doctors who improve care coordination for the patients.

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Nearly 500 practices and more than 2,300 providers are participating in the initiative. "The RECs in New Jersey, Arkansas, New York and Cincinnati are currently working with the [Medicare and Medicaid] Innovation Center to support providers participating in the initiative," the ONC report noted.

Meanwhile, CMS has enrolled 220 ACOs in its Medicare shared savings program. Some of these ACOs enlisted RECs to help them adopt certified EHR technology and to begin measuring and reporting on electronic clinical quality measures. Other RECs, with ONC's encouragement, also have started offering their services to ACOs, the report said. "In several cases," it added, "providers that were participating in the ACOs were previously assisted by the RECs."

Altogether, ONC has allotted $677 million for the operations of the RECs over the next two years.

All of this represents a fair amount of mission creep for the 62 RECs, some of which are also involved in statewide health information exchanges. Originally, the RECs were designed purely to help small primary care practices select and implement EHRs. But having surpassed their goal for that mission, they're now applying their expertise to other objectives of healthcare reform.

Through March 26, 2013, the report said, 133,606 primary care providers, or 44% of the total in the U.S., had enrolled in the RECs. Of these, 101,640 were primary care physicians, 43% of all such doctors. Also included were 20,306 nurse practitioners, 9,654 physician assistants, and 2,006 nurse midwives. The RECs are also working with more than 10,000 specialists who asked for assistance in achieving Meaningful Use.

Of the grand total of 145,536 providers participating in RECs, 116,578 have gone live on an EHR, and 53,582 have demonstrated Meaningful Use, according to the report. A Government Accountability Office (GAO) report cited by ONC found that Medicare providers working with RECs were 2.3 times more likely to receive an EHR incentive payment than those who were not working with a REC.

Also of interest is the fact that the RECs have successfully reached out to support primary care providers operating in medically underserved regions. REC enrollment rates were highest in rural areas (56% of PCPs) and areas surrounding midsized towns (47%).

The types of organizations with the largest percentages of providers enrolled in RECs include private practices of 10 or fewer doctors (36%), community health centers (16%), "practice consortiums" (15%), public hospitals (12%), and organizations in other underserved settings (12%). Many of these providers were able to get EHR incentive payments in the first year by meeting the adopt/implement/upgrade requirements of Medicaid, meaning they didn't have to show Meaningful use.

Another little-known fact about the program is that 77% of critical access hospitals and 46% of other small rural hospitals are working with a REC.