It's no surprise that disproportionate share hospitals, whose population they serve through Medicaid comprises mostly poor people, are lagging in EHR adoption, which a new survey reported in Health Affairs. What is disconcerting, the survey goes on to reveal, is that the way ARRA is structured may actually prevent funds from going to these most-deserving hospitals.

In order for disproportionate share hospitals to get a piece of the more than $30 billion funding to adopt health IT, states must pay for the overhead costs. If states refuse or simply can't cover overhead costs - and with so many states with massive budget deficits this could be a reality - the stimulus money may not reach the disproportionate share hospitals. Huh? Talk about unintended consequences.

The Centers for Medicare and Medicaid Services had no comment, other than calling the revelation a "new wrinkle." It's useless to ask how, in crafting the legislation, legislators could not have foreseen this wrinkle. One hopes that the Dept. of Health and Human Services and the Office of the National Coordinator for Health IT, tasked with overseeing the distribution of federal stimulus funds, are working to fix the problem swiftly.

Do you penalize states who refuse to participate to force them to participate, otherwise known as the stick approach? Or do you try to help out poorer states by using a sliding scale of sorts for overhead payment? Any suggestions for HHS and ONC?

I do have one suggestion, targeted at EHR and EMR vendors. By all accounts, they are in a boom market, thanks to the push for health IT adoption and ARRA. How about if they offer EHRs to disproportionate share hospitals at below-market rates?