Although federal EHR incentive programs have been a shot in the arm for physicians adopting the digital systems, new findings highlight a potential detrimental effect on patient care arising from systematic differences between physicians who have participated in the programs consistently and those who have not.
Using payment data from HHS for 2011 and 2012 — the first two years following the launch of the $30 billion Medicare and Medicaid EHR incentive programs — researchers from New York City-based Weill Cornell Medical College reported that for more than 26,000 physicians in New York, participation in the Medicaid incentive program rose from 6.1 to 8.5 percent and participation in the Medicare incentive program rose from 8.1 to 23.9 percent.
Prior EHR use, access to financial resources, and organizational capacity were physician characteristics associated with early and consistent participation in the meaningful-use initiative, researchers found. Annual participation requirements, coupled with different options to meet meaningful-use criteria under the incentive programs, create disparate groups of physicians, which illustrates the need to monitor participants for continued participation, according to the study.
Physicians who adopted the program may provide higher quality care and more reliable communication with their patients, which could create a digital divide between patients of physicians who do not use EHRs and those who do, according to Hye-Young Jung, PhD, lead author of the study and an assistant professor of policy and research at Weill Cornell.
The findings demonstrate the various difficulties in moving from EHR adoption to actual practical use of the systems, the researchers reported. Patients whose physicians do not adopt the programs will not benefit from any improvements in quality created by EHRs in association with those programs.
"The expectation is that physicians and hospitals should be electronic," Joshua Vest, PhD, senior author and assistant professor of healthcare policy and research at Weill Cornell, said in a statement. "How would everybody feel if only half of the banks were electronic nowadays? Without additional support to move forward there is the potential to stall out among those who don't have the resources or capability to adopt EHRs."
Researchers found that more than half of the physicians who participated in the Medicaid incentive program in 2011 did not do so again in 2012. While the Medicaid program, unlike the Medicare program, allows physicians to skip a year of participation, researchers suggested that many of the physicians likely dropped out of the program. This could either be because they did not treat enough Medicaid patients to meet the minimum requirement for participation in the program or they had less money to support EHR use as a result of lower reimbursement.
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