There are "systematic differences" between providers who participated in Medicare and Medicaid electronic health record (EHR) incentive programs early and consistently from those who did not, which could lead to disparities in patient care, according to new research from Weill Cornell Medical College.
The study, which was published online June 8 and will appear in the June issue of Health Affairs, examined more than 2,6000 physicians across New York State. The Centers for Medicare and Medicaid Services (CMS) and the state Department of Health provided payment data from 2011 to 2012, the first two years of the meaningful use program.
The researchers found that participation in the Medicaid incentive program rose from 6.1 percent to 8.5 percent between the two years, and that participation in the Medicare incentive program rose from 8.1 percent to 23.9 percent. They also discovered that early and consistent participants had greater financial resources, more organizational capacity to support the use of health information technology and prior experience with technology.
The findings illuminate the challenges in moving from EHR adoption to actual use of the systems, the investigators say, which could potentially impact patient care and larger healthcare policy initiatives. "Those physicians who adopted the program may provide higher quality care to their patients," concluded lead author Dr. Hye-Young Jung, Ph.D., an assistant professor of healthcare policy and research at Weill Cornell. "This difference may create a digital divide."
If a digital divide develops, patients of doctors who keep paper—not electronic—records will have less reliable documentation and weaker communication between their healthcare providers. Those patients will not benefit from any quality improvements created by EHRs that are supported by the programs, noted the researchers.
What's more, the findings can have a significant impact on healthcare policy. For example, more than half of the physicians who participated in the Medicaid incentive program in 2011 did not participate in 2012. Unlike the Medicare incentive program, the Medicaid program allows physicians to skip one year of participation, but many of these physicians likely dropped out of the program, the researchers said. This change could be because physicians didn't treat enough Medicaid patients to meet the minimum requirement for participation, or that the physicians had less money to support EHR use as a result of lower reimbursements, according to the investigators.
As such, if many of the participating physicians do not successfully maintain EHRs implemented by the program funding, the government will receive a markedly lower return on investment than anticipated, the investigators said. This highlights the need for healthcare policy that continually monitors participation in the incentive programs to ensure that all patients receive the highest possible quality of care, they said.