Growth Of New York Physician Participation In Meaningful Use Of Electronic Health Records Was Variable, 2011–12

The impact of county-level factors on meaningful use of electronic health records (EHRs) among primary care providers

This study examines the impact of county-level factors on "meaningful use" (MU) of electronic health records (EHRs) for 8415 primary care providers (PCPs) that enrolled in the Florida Medicaid EHR Incentive Program through adopting, improving, or upgrading (AIU) a certified EHR technology. PCPs received incentive payments at enrollment and if they used their EHRs in meaningful ways; ways that benefit patients and providers alike they received additional payments. We conducted a retrospective cohort study of these providers over the 2011-2018 period while linking their records to other state data. We used the core constructs of the resource dependence theory (RDT), a well-established organization theory in business management, to operationalize the county-level variables. These variables were rurality, poverty, educational attainment, managed care penetration, changes in population, and number of PCPs per capita. The unit of analysis was provider-years. For practical and computational purposes, all the county variables were dichotomized. We used analysis of variance (ANOVA) to test for differences in MU attestation rates across each county variable. Odds ratios and corresponding 95% confidence intervals were derived from pooled logistic regressions using generalized estimated equations (GEE) with the binomial family and logit link functions. Clustered standard errors were used. Approximately 42% of these providers attested to MU after receiving first-year incentives. Rurality and poverty were significantly associated with MU. To some degree, managed care penetration, change in population size, and number of PCPs per capita were also associated with MU. Policy makers and healthcare managers should not ignore the contribution of county-level factors in the diffusion of EHRs among physician practices. These county-level findings provide important insights about EHR diffusion in places where traditionally underserved populations live. This county-perspective is particularly important because of the potential for health IT to enable public health monitoring and population health management that might benefit individuals beyond the patients treated by the Medicaid providers.

Provider participation in the Florida Medicaid Promoting Interoperability program: Practice characteristics, meaning use attestations, and incentive payments

OBJECTIVE

The objective of this study was to quantify the rate of provider participation beyond year 1 incentive in the Florida Medicaid Promoting Interoperability (PI) program, formerly the Electronic Health Record Incentive program, and identify the provider and practice characteristics associated with Meaningful Use attestations.

METHODS AND MATERIALS

We conducted a retrospective cohort study using the 2011-2018 records from the PI program, Provider Participation Database. Bivariate associations between Meaningful Use and categorical and ordinal variables were tested using Chi-square and Mantel-Haenszel Chi-square, respectively, with results informing logistic regressions. Adjusted odds ratios and 95 % confidence intervals are reported.

RESULTS

We found that 42.56 % of Florida Medicaid providers achieved Meaningful Use after receiving first-year incentives. Logistic regression showed that pediatricians represented the largest percentage of providers who achieved Meaningful Use (65.06 %) while dentists had the lowest Meaningful Use (7.78 %). We also found that certain geographic areas and various EHR vendors were associated with higher rates of providers Meaningful Use attestation.

DISCUSSION

Although the PI program successfully influenced the adoption of a basic EHR system, low Meaningful Use attestations have inadvertently created a digital "advanced use" divide among providers who serve large numbers of Medicaid patients. This is concerning because advanced EHR functions are necessary precursors to address unmet socioeconomic needs to reduce health disparities.

CONCLUSION

Florida has distributed over $100 million to Medicaid providers who ultimately did not achieve Meaningful Use after collecting their first-year incentive. Policy interventions that can promote advanced EHR use functions are necessary to optimize technology in low-resourced practice settings where the potential benefits are greater.

Utilization of Social Determinants of Health ICD-10 Z-Codes Among Hospitalized Patients in the United States, 2016-2017

BACKGROUND

The inclusion of Z-codes for social determinants of health (SDOH) in the 10th revision of the International Classification of Diseases (ICD-10) may offer an opportunity to improve data collection of SDOH, but no characterization of their utilization exists on a national all-payer level.

OBJECTIVE

To examine the prevalence of SDOH Z-codes and compare characteristics of patients with and without Z-codes and hospitals that do and do not use Z-codes.

RESEARCH DESIGN

Retrospective cohort study using 2016 and 2017 National Inpatient Sample.

PARTICIPANTS

Total of 14,289,644 inpatient hospitalizations.

MEASURES

Prevalence of SDOH Z-codes (codes Z55-Z65) and descriptive statistics of patients and hospitals.

RESULTS

Of admissions, 269,929 (1.9%) included SDOH Z-codes. Average monthly SDOH Z-code use increased across the study period by 0.01% per month (P<0.001). The cumulative number and proportion of hospitals that had ever used an SDOH Z-code also increased, from 1895 hospitals (41%) in January 2016 to 3210 hospitals (70%) in December 2017. Hospitals that coded at least 1 SDOH Z-code were larger, private not-for-profit, and urban teaching hospitals. Compared with admissions without an SDOH Z-code, admissions with them were for patients who were younger, more often male, Medicaid recipients or uninsured. A higher proportion of admissions with SDOH Z-codes were for mental health (44.0% vs. 3.3%, P<0.001) and alcohol and substance use disorders (9.6% vs. 1.1%, P<0.001) compared with those without.

CONCLUSIONS

The uptake of SDOH Z-codes has been slow, and current coding is likely poorly reflective of the actual burden of social needs experienced by hospitalized patients.

Meaningful Use: Does Physician Participation Move the Needle on Quality Metrics?

INTRODUCTION

To determine the association between pattern of participation in the Meaningful Use (MU) initiative and self-reported clinical quality metrics.

METHODS

We used state-level Medicaid electronic health record (EHR) incentive program data to categorize physicians based on receipt of MU payments (single year vs. multiple years) and self-reported quality metrics from 2011 to 2016.

RESULTS

Among 4,198 participating physicians, only 36% received more than one EHR incentive payment. Physicians participating for a single year had better cancer-screening metrics. By comparison, physicians who participated for multiple years reported better medication-related metrics and chronic disease management metrics.

CONCLUSIONS

Nature of participation may have varying degrees of influence on types of clinical quality metrics. Sustained participation may support management of chronic conditions. Administrative claims data will help to elucidate our findings.

Medicare Incentive Payments to United States Ophthalmologists for Use of Electronic Health Records: 2011-2016

PURPOSE

To investigate ophthalmologists' rate of attestation to meaningful use (MU) of their electronic health record (EHR) systems in the Medicare EHR Incentive Program and their continuity and success in receiving payments in comparison with other specialties.

DESIGN

Administrative database study.

PARTICIPANTS

Eligible professionals participating in the Medicare EHR Incentive Program.

METHODS

Based on publicly available data sources, subsets of payment and attestation data were created for ophthalmologists and for other specialties. The number of eligible professionals attesting was determined using the attestation data for each year and stage of the program. The proportion of attestations by EHR vendor was calculated using all attestations for each vendor.

MAIN OUTCOME MEASURES

Numbers of ophthalmologists attesting by year and stage of the Medicare EHR Incentive Program, incentive payments, and number of attestations by EHR vendor.

RESULTS

In the peak year of participation, 51.6% of ophthalmologists successfully attested to MU, compared with 37.1% of optometrists, 50.2% of dermatologists, 54.5% of otolaryngologists, and 64.4% of urologists. Across the 6 years of the program, ophthalmologists received an average of $17 942 in incentive payments compared with $11 105 for optometrists, $16 617 for dermatologists, $20 203 for otolaryngologists, and $23 821 for urologists. Epic and Nextgen were the most frequently used EHRs for attestation by ophthalmologists.

CONCLUSIONS

Ophthalmology as a specialty performed better than optometry and dermatology, but worse than otolaryngology and urology, in terms of the proportion of eligible professionals attesting to MU of EHRs. Ophthalmologists were more likely to remain in the program after their initial year of attestation compared with all eligible providers. The top 4 EHR vendors accounted for 50% of attestations by ophthalmologists.

Electronic Medical Record Use and Maternal and Child Care and Health

OBJECTIVES

To evaluate effects of EHR adoption and use during pregnancy on maternal and child health care utilization and health among pregnant mothers and their infants.

METHODS

The study population was comprised of all Medicaid-insured pregnant women who delivered a singleton birth in Michigan between 1/1/2009 and 12/31/2012 and their infants (N = 226,558). Linked data included birth records, maternal and infant medical claims, and EHR adoption, implementation, upgrading and meaningful use data. Pre-post comparisons with a control group (difference-in-difference) took advantage of a natural experiment of EHR adoption and use among providers in Michigan. Women and infants who received care from providers who adopted and used EHR were compared with those who received care from other providers, in a quasi-experimental framework.

RESULTS

Over 34 % of all women in the analytic sample received perinatal care from providers who adopted and used EHR. Multivariate regressions indicate that women who received prenatal care mainly from a provider who adopted and used EHR were more likely to have any well-child visits (0.05, p = 0.04), and the appropriate number of well-child visits during the first year of life (0.03, p < 0.01).

CONCLUSIONS

The findings of this study are consistent with EHR adoption and use supporting improved child health care utilization. The findings have the potential to provide Medicaid and other healthcare program officials with evidence of the potential gains to be derived from EHRs for vulnerable low-income women and infants.

Medicaid Stage 1 Meaningful Use EHR Incentive Payments Are Associated With Higher Quality but Not Improvements in Quality

This was a retrospective cohort study of ambulatory care quality by physicians who received payment for Medicaid Stage 1 Meaningful Use (MU) in 2012 using New York State Medicaid Claims (2010-2013). Eight quality measures were used to compare performance of physicians who received payments to Adopt, Implement, or Use (AIU) an electronic health record in 2011 but not for MU in 2012 (AIU-only group) and physicians who cared for Medicaid patients but received no payments (no-incentive group), using propensity score-weighted difference-in-difference logistic regression analyses, clustering by physician. In all, 13 697 physicians and 913 476 patients were studied. In 2010, the MU group scored higher than both groups (vs AIU-only in 3 of 8 measures, 0.8-1.3 adjusted percentage points; vs no-incentive, 2 of 8 measures, 0.9-2.0 adjusted percentage points). The difference-in-difference analysis found no additional improvements in quality over time relative to either control group. Longer follow-up is needed to determine the effects of Stage 2 MU.