Meaningful Use of Electronic Health Records and Medicare Expenditures: Evidence from a Panel Data Analysis of U.S. Health Care Markets, 2010–2013

Lammers, M.P.P. Eric J.; McLaughlin, Catherine G.

doi:10.1111/1475-6773.12550

Cited by 15 publications

(13 citation statements)

References 34 publications

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“…Focusing practice purchases toward physicians achieving MU could have benefited organizations by smoothing the assimilation process and by reducing the need for software purchases or training while allowing them to maximize the accompanying subsidies from the HITECH Act. Vertically integrated systems may have also helped facilitate improved quality and coordination of care offered to patients—consistent with some recent evidence …”

Section: Discussionsupporting

confidence: 68%

Horizontal and vertical integration's role in meaningful use attestation over time

Everson

Richards

Buntin

2019

Health Services Research

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Objective To compare rates of attestation and attrition from the MU program by independent, horizontally integrated, and vertically integrated physicians and to assess whether MU created pressure for independent physicians to join integrated organizations. Data Source/Study Setting Secondary Data from SK&A and Medicare MU Files, 2011‐2016. Office‐based physicians in the 50 United States and District of Columbia. Study Design We compared attestation rates among physicians that remained independent or integrated throughout the study period. We then assessed the association between changing integration and MU attestation in multivariate regression models. Principal Findings Our sample included 291 234 physicians. Forty nine percent of physicians that remained independent throughout the period attested to MU at least once during the program, compared with 70 percent of physicians that remained horizontally or vertically integrated physicians. Only approximately 50 percent of independent physicians that attested between 2011 and 2013 attested in 2015, representing significantly more attrition than we observed among integrated physicians. In multivariate regression models, physicians that joined these organizations were more likely to have attested to MU prior to integrating and this difference increased following integration. Conclusions These findings point toward a growing digital divide between physicians who remain independent and integrated physicians that may have been exacerbated by the MU program. Targeted public policy, such as new regional extension centers, should be considered to address this disparity.

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Section: Discussionsupporting

confidence: 68%

Horizontal and vertical integration's role in meaningful use attestation over time

Everson

Richards

Buntin

2019

Health Services Research

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“…Our results show that the growth in adoption and use of EHRs by physicians in ambulatory care settings has a modest negative association with ACSC admissions among chronically ill Medicare patients that is consistent with policy goals. For further context, we note that in a separate analysis reported elsewhere we estimated approximately $1.6 billion in reductions for Medicare Part A acute care expenditures among the same population of patients as in this study that was associated with the increase in physician ambulatory care EHR use during 2010–2013 (Lammers and McLaughlin ). It is likely that these expenditure reductions are due in large part to the reduction in ACSC admissions found in this study.…”

Section: Discussionmentioning

confidence: 57%

Physician EHR Adoption and Potentially Preventable Hospital Admissions among Medicare Beneficiaries: Panel Data Evidence, 2010–2013

Lammers

McLaughlin

2016

Health Services Research

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Objective. To test for correlation between the growth in adoption of ambulatory electronic health records (EHRs) Study Design. Fixed effects model estimated the relationship between hospital referral region (HRR) level measures of physician EHR adoption and ACSC admissions and readmissions. Analyzed rates of admissions and 30-day readmissions per beneficiary at the HRR level (restricting the denominator to beneficiaries in our sample), adjusted for differences across HRRs in Medicare beneficiary age, gender, and race. Calculated physician EHR adoption rates as the percentage of physicians in each HRR who report using EHR in ambulatory care settings. Principal Findings. Each percentage point increase in market-level EHR adoption by physicians is correlated with a statistically significant decline of 1.06 ACSC admissions per 10,000 beneficiaries over the study period, controlling for the overall time trend as well as market fixed effects and characteristics that changed over time. This finding implies 26,689 fewer ACSC admissions in our study population during 2010 to 2013 that were related to physician ambulatory EHR adoption. This represents 3.2 percent fewer ACSC admissions relative to the total number of such admissions in our study population in 2010. We found no evidence of a correlation between EHR use, by either physicians or hospitals, and hospital readmissions at either the market level or hospital level.Conclusions. This study extends knowledge about EHRs' relationship with quality of care and utilization. The results suggest a significant association between EHR use in ambulatory care settings and ACSC admissions that is consistent with policy goals to improve the quality of ambulatory care for patients with chronic conditions. The null findings for readmissions support the need for improved interoperability

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“…1 Particularly for patients with expensive chronic ambulatory care-sensitive conditions, such as diabetes, the use of EHR systems in primary care is regarded as having important potential to improve care provision through improved organization and exchange of patient information. 2 The association of EHR systems in primary care with health care utilization has been investigated, with some evidence of improvements in health care delivery and outcomes. Evidence has shown that implementation of EHR systems may be associated with reductions in emergency visits and hospital admissions among patients with diabetes.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an Electronic Health Record System With a Disease Management Program and Health Care Treatment Costs for Danish Patients With Type 2 Diabetes

2020

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IMPORTANCE Electronic health record (EHR) systems and disease management programs (DMP) are often promoted, but associated health care cost changes are not well understood. OBJECTIVE To evaluate the association between annual health care costs of patients with type 2 diabetes and the use of an electronic health record system with a disease management program (EHR/DMP) in general practice. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined patients with type 2 diabetes in Denmark between January 1, 2008, and December 31, 2014, who attended practices that either used an EHR/DMP at a high level or never used the disease management system. An EHR/DMP system was rolled out across general practices in Denmark beginning in 2011 and was discontinued in 2014. Data were analyzed between March 2019 and March 2020. MAIN OUTCOMES AND MEASURES The main outcome was total health care costs, and the secondary outcomes were primary care, medication, nonhospital specialist, and hospital (total, outpatient, inpatient, and emergency) costs. Regression models were used to estimate EHR/DMPassociated percentage differences in patients' annual health care treatment costs across health care treatment categories. All models included general practice-level fixed effects and patient-level controls. Two-part models examined robustness of estimated associations for hospital cost categories. RESULTS Of 33 970 patients included in the analysis, 15 953 (8016 [50.2%] male; mean [SD] age, 59.9 [13.3] years) attended 244 general practices that used the system at a high level, and 18 017 (9291 [51.6%] male; mean [SD] age, 60.0 [12.9] years) attended 344 general practices that had never used the system. Use of the EHR/DMP was associated with 3.2% higher (95% CI, 0.9%-5.6%) annual general practice treatment costs and with 6.4% lower (95% CI,-11.6% to-1.2%) annual hospital emergency visit costs. The associations between EHR/DMP use and annual total hospital (percentage difference, −0.8%; 95% CI, −7.5% to 5.7%) and total health care (percentage difference, −0.1%; 95% CI, −2.1% to 1.9%) cost changes were not statistically significant. CONCLUSIONS AND RELEVANCE Among patients with type 2 diabetes, attendance at general practices that used an EHR/DMP was associated with a moderate increase in primary care costs and a reduction in emergency hospital visit costs but no significant change in total health care costs. Large health care cost savings associated with improved use of EHR-based disease management systems should not be expected to be realized in the short term.

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Meaningful Use of Electronic Health Records and Medicare Expenditures: Evidence from a Panel Data Analysis of U.S. Health Care Markets, 2010–2013

Abstract: Health care markets that had steeper increases in EHR penetration during 2010-2013 also had steeper decreases in total Medicare and acute care expenditures per beneficiary. Markets with greater increases in physician EHR had greater declines in Medicare Part B expenditures per beneficiary.

Cited by 15 publications

References 34 publications

Horizontal and vertical integration's role in meaningful use attestation over time

Horizontal and vertical integration's role in meaningful use attestation over time

Physician EHR Adoption and Potentially Preventable Hospital Admissions among Medicare Beneficiaries: Panel Data Evidence, 2010–2013

Evaluation of an Electronic Health Record System With a Disease Management Program and Health Care Treatment Costs for Danish Patients With Type 2 Diabetes

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