Did meaningful use create a 'digital divide'?

Docs who signed on early to MU and stayed on board 'may provide higher quality care to their patients'
By Mike Miliard
09:46 AM
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Two divided groups of people

A new study from Weill Cornell Medical College, published this week in Health Affairs, points to the emergence of "systematic differences" between physicians who participated in the Medicare and Medicaid EHR Incentive Programs and those who didn't.

[See also: Meaningful use criteria 'too high and too many']

That "could lead to disparities in patient care," according to Weill Cornell researchers, who examined 26,368 physicians across New York State, using payment data from 2011 to 2012, the first two years of meaningful use.

Docs' participation in the Medicaid incentive program rose from 6.1 percent to 8.5 percent between those two years, researchers say, while participation in the Medicare incentive program rose from 8.1 percent to 23.9 percent.

[See also: Eligible Provider "Meaningful Use" Criteria]

"Early and consistent participants" were shown to have greater financial resources, more organizational capacity to support the use of health information technology and prior experience with technology, according to researchers.

"Those physicians who adopted the program may provide higher quality care to their patients," Hye-Young Jung, assistant professor of healthcare policy and research at Weill Cornell, and the study's lead author, in a statement. "This difference may create a digital divide."

Such a disparity means that patients of physicans who rely on paper records "will have less reliable documentation and weaker communication" between their providers, researchers point out, and won't enjoy the benefits of any EHR-enabled quality improvements.

Looking at longitudinal patterns in an effort to spot trends related to nonparticipation, noncontinuous participation, switching programs and late adoption, the researchers found that many EPs who enrolled in the Medicaid incentive program in 2011 didn't participate in either program in 2012.

While that may be because they were skipping a year (as the Medicaid program, unlike the Medicare version allows), Weill Cornell researchers say the physicians likely dropped out, either because they didn't treat enough Medicaid patients to meet the minimum requirement for participation, or because lower reimbursements meant they had less money to spend on technology.

But the government "will receive a markedly lower return on investment" if EHRs aren't maintained past the initial flush of incentive money, according to researchers.

"The expectation is that physicians and hospitals should be electronic," said Joshua Vest, assistant professor of healthcare policy and research at Weill Cornell Medical College. "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."

Access the full study here.