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

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

doi:10.1111/1475-6773.12586

Cited by 20 publications

(15 citation statements)

References 25 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%

“…Data on ambulatory physicians were from a commercial research firm, SK&A, and included the years 2011, 2013, and 2015, with more than 500 000 physicians represented in each year of the data. SK&A aims to collect information on all office‐based physician practices in the United States via regularly scheduled phone interviews, and this data source has previously been used to measure physician EHR adoption, practice characteristics, and physician integration behavior . We used physician's national provider identifiers (NPIs) to combine these data with the Medicare MU Attestation Eligible Professionals Public Use Files (PUF) (https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/PUF.html) and the Medicare Provider Utilization and Payment Data.…”

Section: Methodsmentioning

confidence: 99%

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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%

Section: Methodsmentioning

confidence: 99%

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

Everson

Richards

Buntin

2019

Health Services Research

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“…The evidence of an association between HIE and various measures of care is lacking, mixed, and mostly dated . An analysis that is part of the global assessment expanded on this prior evidence by examining data from 2010 to 2013, testing for correlations between the growth in health IT before and after the enactment of HITECH and hospital admissions and readmissions for Medicare beneficiaries with at least 1 of 4 chronic conditions—chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes, and ischemic heart disease (IHD) . The analysis found that increases in hospital referral region–level health IT penetration among physicians in ambulatory care settings were correlated with decreases in ambulatory care sensitive condition (ACSC) admissions for these Medicare patients.…”

Section: Implementation Experiencementioning

confidence: 99%

Assessing HITECH Implementation and Lessons: 5 Years Later

2016

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Achieving the expansive goals of HITECH required the simultaneous development of a complex and interdependent infrastructure and a wide range of relationships, some better positioned to move forward than others. To date, it has proven easier to get providers to adopt EHRs, perhaps in response to financial incentives to do so, than to develop a robust infrastructure that allows the information in EHRs to be used effectively and shared not only within clinical practices but also across providers. Effective exchange of data is necessary to drive the kinds of delivery and payment reforms sought nationwide.

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“…There is mixed evidence on the impact of these processes; much of this evidence comes from studies of practices that have volunteered to participate (so may differ from practices that do not volunteer) and/or are located in limited geographic areas (Friedberg et al. ; Lammers, McLaughlin, and Barna ; Sinaiko et al. ; Unruh et al.…”

mentioning

confidence: 99%

Medical Group Characteristics and the Cost and Quality of Care for Medicare Beneficiaries

Casalino

Ramsay

Baker

et al. 2018

Health Services Research

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Objective To estimate the relationship between outcomes of care and medical practices’ structure and use of organized care improvement processes. Data Sources/Study Setting We linked Medicare claims data to our national survey of physician practices (2012–2013). Fifty percent response rate; 1,040 responding practices; 31,888 physicians; 868,213 attributed Medicare beneficiaries. Study Design Cross‐sectional observational analysis of the relationship between practice characteristics and total spending, readmissions, and ambulatory care–sensitive admissions (ACSAs), for all beneficiaries and five categories of beneficiary defined by predicted need for care. Principal Findings Practices with 100+ physicians and 50–99 physicians had, respectively, annual spending per high‐need beneficiary that was $1,870 (12.5 percent) and $1,824 higher than practices with 1–2 physicians, and readmission rates 1.64 and 1.71 higher. ACSA rates did not vary significantly by practice size. Outcomes did not vary significantly by ownership or by practices’ use of organized processes to improve care. Conclusions Large practices had higher spending and readmission rates than the smallest practices, especially for high‐need beneficiaries. There were no significant performance differences between physician‐owned and hospital‐owned practices. Policy makers should consider the effects of specific policies on provider organization, pending further research to learn which types of practice provide better care.

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

Cited by 20 publications

References 25 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

Assessing HITECH Implementation and Lessons: 5 Years Later

Medical Group Characteristics and the Cost and Quality of Care for Medicare Beneficiaries

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