Electronic medical records will improve the safety, quality and efficiency of health care in rural areas, hospital and clinic administrators say.
But the records, already available at many hospitals in larger cities, are a major expense for small facilities, many of which say they struggle financially. Most don't have the records yet.
Some rural administrators worry they won't meet the requirements for government payments starting next year to help offset the cost. Facilities that don't have the records fully in place by 2015 will be penalized by lower payments from Medicare and Medicaid.
In Mauston, about 75 miles northwest of Madison, Mile Bluff Clinic will spend more than $2 million to implement the records, said administrator Carol Fronk. The clinic got broadband capacity in August to support the records. But connections to satellite clinics — in Elroy, Lake Delton and Necedah — lack broadband, an obstacle in many small towns.
For Mile Bluff to qualify for a government reimbursement of up to $1.5 million, at least 30 percent of its patients must be on Medicaid or poor, Fronk said. The clinic exceeds that figure now but could fall below it, she said.
Even if that rule is met, the clinic might not receive the full $1.5 million because the formula focuses on doctors, and many providers at the clinic are physician assistants, Fronk said.
"Why did they put so many limitations on rural clinics?" she asked.
Memorial Medical Center in Neillsville, about 160 miles northwest of Madison, will spend $1.2 million to install the records. That's nearly twice what the hospital made last year, said Scott Polenz, chief executive officer.
Memorial, which lost $250,000 the year before, sold its money-losing nursing home this year to prepare for the cost of electronic records, Polenz said.
"It's a huge impact," he said.
Stoughton Hospital is spending $1.6 million to launch electronic records early next year, said Karen Myers, vice president of financial services. She said the hospital is able to move quicker than some because of its affiliation with SSM Health Care of Wisconsin, which is also assisting hospitals in Columbus and Edgerton.
Of Wisconsin's 69 rural hospitals, about a dozen are well positioned to start using the records on time and receive substantial reimbursements, said Louis Wenzlow, health information technology director at the Rural Wisconsin Health Cooperative in Sauk City.
Another dozen or so hospitals are making significant strides, but the rest are struggling, Wenzlow said.
Most of the hospitals must spend large sums before learning if their expenses qualify for government help, he said. The requirements are so complicated that many hospitals — most are considered "critical access" hospitals — could fail to get payments, he said.
"Critical access hospitals can't afford to make a mistake," he said.