Bruen, Brian K.

Buntin, Melinda

Burke, Matthew

Ku, Leighton C.

English

George Washington University: Health Sciences Research Commons (HSRC)

The Promise and Potential ofFederal Incentives forElectronic Health RecordsBrian Bruen,1 Leighton Ku,1Matthew Burke,2 and Melinda Buntin21 George Washington University2 Office of the National Coordinator for Health Information TechnologyKey Findings• Incentives could greatly accelerate use of HIT by physicians• Programs are generally well-targeted, but key groups may be excluded• Policy makers and stakeholders can help alleviate gapsOverview• Summary of federal incentive program• Study methods and results• Policy impact and recommendations• The publishing processPercentage of office-based physicians with electronic health record (EHR) systems18.2% 17.3% 17.3%20.8%23.9%29.2%34.8%42.0%48.3% 50.7%10.5% 11.8%16.9%21.8%24.9%3.1% 3.8% 4.5%6.9%10.1%0%10%20%30%40%50%60%2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Percent of PhysiciansYearAny EHR systemBasic systemFully functional systemSource: Hsiao, C.J., Hing, E., Socey, T.C. & Cai, B. (2010). Electronic medical record/electronic health record systems of office-based physicians: United States, 2009 and preliminary 2010 state estimates. Hyattsville, MD: National Center for Health Statistics.Going HITECH• The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.– CMS, Official Web Site for the Medicare and Medicaid Electronic Health Records (EHR) Incentive ProgramsMedicare Incentives• Up to $44,000 for physicians who treat Medicare patients• Must demonstrate meaningful use each year to receive incentives• Reduced Medicare reimbursements starting in 2015 for those who do not demonstrate meaningful useMedicaid Incentives• Up to $62,750 for physicians with at least 30% Medicaid volume– 20% for pediatricians– Community health centers, rural clinics can include uncompensated care• 1st year incentive to adopt, implement, or upgrade; must demonstrate meaningful use in years 2-6• Can get Medicaid OR Medicare incentivesMeaningful Use• HITECH provisions specify 3 components of “Meaningful Use:”1. Use of certified EHR in a meaningful manner (e.g., e-prescribing)2. Use of certified EHR technology for electronic exchange of health information to improve quality of health care3. Use of certified EHR technology to submit clinical quality measures (CQM) and other measures selected by the SecretaryStages of Meaningful Use• Criteria to be established in three stages:– Stage 1 (July 2010): baseline for electronic data capture and information sharing– Stages 2 (est. 2013) and 3 (est. 2015) will expand on this baselineMethods & Data• Data: National Ambulatory Medical Care Survey (NAMCS) 2007-2008 surveys• Electronic medical records (EMRs) vs. electronic health records (EHRs)• Use of “basic” systems measured using methods comparable to earlier studies• Eligibility for incentives based on physicians’ sampled visits from Medicare and Medicaid patients – not meaningful useResults: By Physician Specialty0% 20% 40% 60% 80% 100%CHCOther SpecialtyPsychiatryOB/GYNPediatriciansG.P./F.P./Int. Med.Overall AveragePercent of PhysiciansUse Basic EHREligible for IncentivesEligible for Medicare IncentivesEligible for Medicaid IncentivesSource: Authors’ calculations based on combined 2007-2008 National Ambulatory Medical Care SurveysResults: By Practice Ownership and Size0%20%40%60%80%100%Percent of PhysiciansUse Basic EHR Eligible for IncentivesEligible for Medicare Incentives Eligible for Medicaid IncentivesSource: Authors’ calculations based on combined 2007-2008 National Ambulatory Medical Care SurveysMultivariate: Factors Affecting EHR UseFactor Marg. Eff. ProbSpecialty (Ref = GP/FP/IM)PediatricsOB/GYNPsychiatry p < .01OtherWorks in CHC p < .01Ownership/Size (Ref = phys., solo)Physician group p < .01HMO p < .01Med./acad. HC p < .01Other health co. p < .05Other ownerFactor Marg. Eff. ProbCensus Region (Ref = East)MidwestSouthWestMetro Status (Ref = not in MSA)in MSAElectronic Billing (Ref = none)All electronic p < .01Part electronic p < .10Percent of Visits Attributable to…MedicareMedicaid p < .10Source: Authors’ calculations based on combined 2007-2008 National Ambulatory Medical Care SurveysOffice-Based Physicians Potentially Eligible For HITECH Incentives And Using Electronic Health Records (EHRs), 2007–08Not eligible for incentives, does not have basic EHR, 14.6%Not eligible for incentives, already has basic EHR, 2.8%Eligible for incentives, already has basic EHR, 12.1%Eligible for incentives, does not have basic EHR, 70.5%SOURCE Authors’ calculations based on combined 2007–08 National Ambulatory Medical Care Surveys. NOTE HITECH is Health Information Technology for Economic and Clinical Health.Highlights from Findings• Incentives should greatly accelerate use of electronic health records– 4 out of 5 office-based physicians could qualify, if they achieve meaningful use• Incentives are well-targeted, but certain groups of physicians are more likely to be excluded– pediatricians, psychiatrists, obstetrician-gynecologistsWill Incentives Use?• Given low levels of EHR use, the incentives are well-targeted and capable of spurring the great majority of physicians to adopt or improve their EHR systems• Overall impact of financial incentives on system adoption is still uncertainSome  G  A  P  S  Persist• Gaps in eligibility for incentives may lead to digital divides, especially for those caring for children or women, and hinder efforts to integrate behavioral and medical care• Some physicians serving Medicare patients may not have enough Medicare volume each year to get the maximum first-year incentiveMedicaid Incentives are Critical• Important to monitor the use and impact of Medicaid incentives on physicians caring for low-income patients, particularly given the large expansion of enrollment for low-income adults planned under health reformPolicy Responses• Monitor gaps in eligibility, use• Pro-rate eligibility for Medicaid incentives• Assist solo practitioners, smaller practices in adopting systems and achieving meaningful use– Government (e.g., ONC) and private roles (e.g., insurers, foundations)In Conclusion• To truly achieve quality improvement and cost savings, physicians, hospitals and other health care providers must use EHRs and other HIT effectively and efficiently in the course of care – meaningful use regulations are vital to this goalPublicizing the Results• AcademyHealth ARM (June 2010)– Poster session; 2006-07 results• University of Maryland WHITE (Oct. 2010)– 1st presentation after opening keynote address!• Health Affairs (March 2011)– Participated in panel discussion at release eventPublishing in Health Affairs• June 2010: discussed paper with editors at AcademyHealth ARM• Sept. 2010: manuscript submitted• Dec. 2010: editors send comments, ask us to update the paper with new data… in less than two weeks, during the holidays• Jan./Feb. 2011: more reviews/editing• March 2011: published

The Promise and Potential of Federal Incentives for Electronic Health Records

https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1010&amp;context=sphhs_policy_facpres

The Promise and Potential of Federal Incentives for Electronic Health Records

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