While grants can help fund IT projects, CIOs should start with defining the need, then look for the money, not the other way around
From: Healthcare Informatics
January 2009
by Mark Hagland
Some say Eastern Maine Health System has had luck on its side in applying for, and receiving, major healthcare IT grants from federal and other agencies. The Bangor-based health system, which encompasses seven hospitals, 729 acute-care beds, 454 long-term care beds, 272 employed physicians, and various other resources, serves the northern two-thirds of Maine. Given its largely rural service base and its comprehensive approach to services, it's not surprising that Eastern Maine has captured a large number of significant grants, among them:
- A $500,000 grant to flagship facility Eastern Maine Medical Center from the U.S. Department of Agriculture (USDA) for the development of a regional teleradiology system, including region-wide PACS.
- A $1.4 million grant to The Aroostook Medical Center for IT development to support chronic disease management, from the Agency for Healthcare Research and Quality (AHRQ).
- A $750,000 grant to the Eastern Maine system from the Health Resources and Services Administration (HRSA) for the development of a telemedicine program to improve access to specialists from rural critical-access hospital EDs and for tele-home care in chronic disease management.
Given the health system challenges facing regions like northern Maine, which are rural and have a large percentage of poor or underprivileged residents, Eastern Maine is well - positioned to garner some grants. But there's much more to it than simply scanning the grants landscape and filling out application forms, stresses Catherine Bruno, vice president and CIO of the system.
Bruno says she and her colleagues, including Jean Mellett, the health system's director of planning, say they feel fortunate in having obtained significant grants to support their IT initiatives. Above all, she says, "If you're going to participate in the grant-seeking process, it needs to align with your organization's priorities."
That dictum applies to every one of the projects that the Eastern Maine has received grants for, Bruno and her colleagues emphasize. For example, their teleradiology program is one that Eastern Maine leaders had already set into motion before receiving the USDA grant. "We wanted to do the program regardless of external funding," Mellett says. "And those are some of the projects we wanted to get funding for, since we had already identified them as priorities for our organization."
Adds Bruno, "You really need to plan a grant process just as you'd plan any project upfront, and then run it like a project." This, she says, entails planning early on for the long, involved post-implementation phase of measurement, evaluation and results reporting. Eastern Maine was named a recipient last October of the 2008 Davies Public Health Award in the organizational category, from the HIMSS Nicholas E. Davies Awards of Excellence Program.
Letting strategy drive process
Erica Drazen
The vast majority of healthcare IT implementations continue to be self-funded or privately funded. But, industry experts say, the need to improve healthcare access and delivery is making a number of grants available.
What's important for CIOs to understand, Bruno says, is that it's critical to pursue grants only when the concept matches the organization's core strategic IT goals. In other words, they advise CIOs to pursue grants for initiatives they plan to pursue anyway, not to scan the grant landscape first.
Edna Boone
Erica Drazen, Sc.D., a partner in the Lexington, Mass.-based Emerging Practices division of CSC Corporation (Falls Church, Va.), says she agrees 100 percent with Bruno and Mellett. "Go for grants for things that you already do or want to do in the future," she says. "If you can't find the money internally for something you want to accomplish around patients taking care of themselves, or group visits, or something else, do it. But don't just look for money for its own sake."
Drazen cites as a negative example the relatively large number of patient care organizations whose executives have applied for health information exchange (HIE) grants in the past few years, simply because funding was available.
On the other hand, Drazen says, some CIOs may be intimidated by the prospect of competing for the small number of grants that are awarded to academic medical centers. "While it's also an issue that people think it's difficult to get this money, the application process for some of these grants, such as the Department of Agriculture grants, is not so onerous," she says. "It's not like getting a grant from the NIH."
Drazen's advice? "People should hook up with their local universities, which have students and lab people and access to the statisticians and so forth; and nursing schools, schools of pharmacy if you're doing something with medication - to really reach out. Because there are grad students looking for places to work."
HIMSS created a new program in the summer of 2008 called the Grants Advantage Program. According to Edna Boone, senior director of healthcare information systems at HIMSS, who is managing the initiative, its purpose is not only to provide healthcare IT executives with general information on the types of grants that are available, but also to give them information on all aspects of the process. Boone and her colleagues run the site (which charges a subscription fee to HIMSS members) in conjunction with a group called The Grants Office, an organization of experienced grant writers based in Rochester, N.Y.
Boone says she believes that the Grants Advantage Program will be of significant help to healthcare executives going forward. "The tool really gives them the ability to go beyond the traditional grants search engines," she says, "because it facilitates both the searching, and also the grants management life cycle." What's more, Boone says, "While community health centers have long been comfortable writing grant applications, the not-for-profit community hospitals historically have not been." But, she says, there is more grant money available, and in more places, than many might suspect.
Boone concurs with Drazen on the importance of pursuing grants only for projects that would be pursued in any case. "You need to ask who your thought-leaders are among physicians and other clinicians in your organization," she says. "You might have a physician who's intensely interested in improving care for congestive heart failure or for diabetes, for example." Most of all, Boone says, "You look at who your clinician champions are and where your core strengths are in terms of clinical service areas."
Academic research grants are generally easier to obtain than IT-oriented grants, but Boone says, in her experience they are also the most difficult to implement.
According to Boone, the challenge in terms of IT grants is often finding out what is available. She says that there's even money for post-implementation training uses. CIOs, she emphasizes, need to be thoughtful, creative, entrepreneurial, and persistent. "You can write a fabulous grant," says Boone, "but you also have to make sure that people know what it is you're trying to achieve as a hospital or health system."
Paul Browne
As a hospital executive, Boone was instrumental in helping her former organization (which she declined to identify) obtain a $3.8 million grant from the state of New York.
Trinity Health's strategic juggernaut
One large health system whose executives have been pursuing grants strategically is the 44-hospital Trinity Health System, based in the Detroit suburb of Novi, Mich. At Trinity, the board and senior management team believe that with the size and scale of the organization comes a unique opportunity to influence the landscape of healthcare in the United States, according to senior vice president and CIO Paul Browne. "So we made a decision many years ago to pursue grants in general terms, because we felt that would provide us with some linkages with public agencies and
public officials," Browne says. "We felt that would help us demonstrate to policy makers some of the objectives we were pursuing; so we felt we could influence healthcare in the U.S. beyond just Trinity." Pursuing grants has been one element in Trinity's broader, public policy-driven strategy.
Philip Stuart
What's more, Browne says, it's important to be strategic about how one pursues grants. Being a community hospital system, he and his colleagues recognized that it would be important to partner with experts at universities that could help provide data research expertise to measure results and outcomes. As a result, Trinity leaders partnered with academic professionals at Iowa City-based University of Iowa, and successfully applied to the federal Agency for Healthcare Research and Quality (AHRQ) for funding. That resulted in a grant for $1.5 million over three years called the "Rural Iowa Redesign of Care Delivery with EHR Function," which helped link several of Trinity's rural hospitals to its Iowa flagship facility, Mercy Medical Center-North Iowa, located in Mason City, Iowa. Another AHRQ grant for $200,000 specifically funded the planning phase of the integrated EHR system to link the eight rural hospitals to Mercy-North Iowa.
Says Tim Eckels, Trinity Health's vice president-public policy, "We made a deliberate decision here to be proactive
about trying to get grants, especially from AHRQ. Part of this is an advocacy initiative, but part of it too is an initiative very much related to Genesis (the health system's broad EHR development initiative). We wanted some help in pioneering we were doing around the electronic health record, but we also wanted some help with our mission more broadly. We see it as part of our mission to movethe healthcare system forward in transparency and quality of delivery. 
And the idea was that we would use lessons we're learning to inform the policy debate in Washington. We actually have a term for this, we call it 'pilots to policy.'" Moving forward on healthcare IT has been one half of the impetus behind the push on grants, but the other half has been to consciously stimulate the national policy discussion around IT.
Bill Bruce
A unique arrangement in western Wisconsin
What's been happening in western Wisconsin says a lot both about trends in healthcare IT granting, as well as how healthcare IT executive management might evolve. To begin with, 35 rural hospitals in the state came together in 1979 to found the Rural Wisconsin Health Care Information Technology Network, an alliance that helps smaller, rural hospitals in the Badger State work on collaborative HIT projects and share expertise gleaned from consultants. Then, a few years ago, four hospitals within that network chose to go a step further - to actually create a shared IT
management entity, the Rural Wisconsin Health Cooperative. The cooperative uses the same core clinical IS vendors, and has hired Louis Wenzlow to be its CIO. And, under Wenzlow's leadership, the RWHC has obtained two significant grants. (By definition, critical-access hospitals are licensed for 25 beds, though the patient care volume among both
the four-hospital and the 35-hospital groups varies considerably.)
The larger of the two grants is for $1.6 million, and is an HRSA Critical Access Hospital Information Technology (CAHIT) grant. That grant has paid for RWHC's shared-HIS server hardware, as well as portions of the system's software, and for some of the cost of establishing the cooperative's shared help center. Thanks to that grant, all four RWHC hospitals - Tomah Memorial Hospital in Tomah, St. Joseph's Community Health Services in Hillsborough, Boscobel Area Health Care in Boscobel, and Memorial Hospital of Lafayette County in Darlington - had gone live with their core EMR/HIS by
late last summer.
The other grant the RWHC received was for $1.5 million, to be paid out over five years, from the Federal Communication Commission's Rural Health Care Pilot Program. As part of that program, the RWHC is one of 69 grantee organizations in 43 states receiving funds for broadband infrastructure development.
"I think we've been pretty successful here," Wenzlow says. With regard to becoming a grant winner, he says, "I think that primarily you need to ask yourself, am I interested in helping the grantor achieve the results that they're after? Is there a good match? There's almost always a patient safety aspect; they also want that. And they'll want to measure how you're making improvements."
Wenzlow's leadership is saluted by the CEOs of the cooperative, including Philip Stuart of Tomah Memorial Hospital and Bill Bruce of St. Joseph's Community Health Services. "The journey involved on our part was to create an information system that could be utilized by multiple small hospitals; that was our strategy," Stuart says. And there was a natural alignment between that strategy and what the grants were looking for. I give the credit to Louis. Finding that fit was key."
The implementation has gone very well also, notes Bruce. "With the four critical-access hospitals banding together, that does create some critical mass," he says. "We were able to purchase IT expertise in nursing care, billing, finance, clinic services, and so forth. If we were standing on our own, there's no way we could afford to purchase that expertise."
Wenzlow agrees that there is a natural dovetailing taking place now among rural critical-access hospitals around IT. The same forces pushing those hospitals together in innovative cooperatives like the RWHC are also the same ones driving a large portion of healthcare IT grant availability, he notes.
At base, federal agencies and other organizations are recognizing the need for smaller, rural hospitals to leverage IT for better patient access, care quality, patient safety, and operational efficiency, just as senior executives from such hospitals are coming to that same awareness.
In the end, all those interviewed agree, it's all about alignment: going after healthcare IT grants means developing an organization's healthcare IT strategies, and then looking to see what kinds of grant funds might be available to match the organization's strategies - not the other way around. Grant-seeking really "needs to align with your organization's priorities," Eastern Maine's Bruno summarizes. "You need to do your homework, because it really is more work to get a grant. And you need to understand that and put a structure in place. Of course," she says, "it really helps to have a fantastic group writing grants."
From: THE LATHROP & GAGE HEALTH LAW BLOG HOUSE CALLS
You may be surprised to learn there has been a dramatic decrease in government enforcement activity in the healthcare industry in the last two years, at least as measured by monies recovered by federal agencies. In FY06, the FBI's annual Financial Crimes Report showed $2.17 billion in recoveries, restitutions, fines, and seizures involving healthcare
organizations. That number was down by more than fifty percent the following year to $1.22 billion. For FY08 (which ended September 30), the Department of Justice reports $1.12 billion from settlements and judgments from healthcare organizations alleged to have defrauded the government.
The HHS Office of Inspector General Semi-Annual Reports to Congress tell the same story. The report for the period
October 2006 to March 2007 shows $1.4 billion in investigative receivables and $1.5 billion in audit receivables. For the
same period a year later, those numbers are down twenty-five percent to $1.1 billion in investigative receivables and
$1.1 billion in audit recoveries.
There are several explanations for this decline other than the government has lost interest in the healthcare industry.
The underlying analysis shows the number of cases the government is pursuing has remained constant, while the
number of settlements over $10 million has declined significantly. Also, the government has been more aggressive in
bringing criminal charges rather than pursuing civil settlements, assuming the threat of jail time has a greater
deterrent effect on providers. Finally, there has been a dramatic increase in enforcement activity at the state level,
with several attorneys general announcing new Medicaid fraud fighting initiatives.
That leads us to the million (and perhaps billion) dollar question: what should we expect from the Obama
Administration with respect to enforcement activity? During his campaign, President-elect Obama championed a
healthcare plan which includes universal health insurance coverage for children and universally available coverage for
adults. He also promised to decrease the cost of health insurance by an average of $2500 per family.
Obama claimed he could pay for his plan through cost savings realized through increased use of health information
technology, improved preventive care and treatment of chronic conditions, eliminating subsidies for Medicare Advantage
plans, introducing competitive bidding under Medicare Part D, and reducing waste and abuse in federal healthcare
programs.
In September 2008, the Obama campaign released its plans to step up government enforcement activity, including
increasing authority for the OIG to fight fraud, implementing anti-fraud measures in contracts awarded by CMS,
expanding Medicare and Medicaid audits, strengthening the False Claims Act by enhancing whistleblower protections,
encouraging states to fight fraud, and increasing funds for efforts by Department of Justice prosecutors and FBI agents
to fight fraud. Obama also said that he would take action against the 27,000 health care providers who participate in
Medicare and owe more than $2 billion in unpaid taxes.
Obama's ambitious plans for healthcare reform may take a temporary backseat to the current financial crisis. The
President-elect's plans for funding such reforms, however, are likely to move forward quickly. We expect newly
appointed DOJ officials and U.S. Attorneys to place an even greater emphasis on healthcare fraud cases.
Now it's our job to figure out what types of cases the government will pursue. We'll offer one prediction right now.
Given Obama's stated desire to increase the use of health information technology (coupled with CMS' and OIG's recent
announcements of their planned increased Security Rule audit activity), we expect to see more HIPAA Security Rule
enforcement. Numerous surveys have reported concerns regarding the confidentiality, integrity, and availability of
electronic health records justify those who say there are too many impediments to increased use of such technology.
Increased enforcement activity is likely to be perceived as one way to encourage providers to invest in administrative,
physical, and technical safeguards to protect their electronic information.