BETHESDA, MD – The good news is that 90.6 percent of physicians working in general or family practice or internal medicine could qualify for federal incentives if they can meet meaningful use criteria. The bad news? Fewer than two-thirds of pediatricians, obstetrician-gynecologists and psychiatrists may be eligible, according to a study published in Health Affairs.

The authors of the study used pooled public use data from the 2007 and 2008 National Ambulatory Medical Care Survey to measure the use of electronic health records by U.S. nonfederal office-based physicians, as the 2009 and 2010 data are not publicly released yet.

[See also: Docs slow to embrace EHRs, but will in time.]

Overall, researchers found that 82.6 percent of office-based physicians could qualify for incentives if they met meaningful use criteria, with some qualifying for Medicare incentives, some for Medicaid incentives and some either of the two. Authors broke physician eligibility into four categories:

• 70.5 percent of physicians are eligible for incentives, but do not have basic EHR. According to authors this represents most office-based physicians.
• 14.6 percent of physicians are not eligible for incentives and do not have a basic EHR. (Eligibility is based on the number of Medicare and Medicaid patients seen.) This is the group authors say is the most likely to resist EHRs.
• 12.1 percent of physicians are eligible for incentives and already have a basic EHR.
• 2.8 percent of physicians are not eligible for incentives and already have a basic EHR.

Whether or not physicians were eligible for receiving incentives, however, varied by specialty, type and size, researcher concluded. They found that psychiatrists, above all other specialists, were "significantly less likely to use EHRs."

Authors also note that physicians in a solo practice are less likely than those in larger practices to use EHRs and qualify for incentives, and physicians in practices owned by a health maintenance organization were the least likely to be eligible for incentives.

[See also: Docs not surprised at EHR survey results.]

The geographic location of the doctor also mattered: physicians in the Midwest were more likely to qualify for incentives and those in the West were less likely to qualify, according to authors.

"One change to consider," said authors, "is making all physicians who treat any Medicaid patients eligible for HITECH incentives, on a prorated basis."

Authors also suggest reducing the amount of care physicians need to provide Medicaid patient in order to qualify for incentives. Because it would require a change in the ARRA act, they noted, that could probably not occur soon.

However, authors did say that, "if after the HITECH incentives have been implemented, research reveals that physicians still are not generally using EHRS and that further incentives would lead to commensurate gains in the quality and efficiency of care, there would be a stronger basis for recommending changes in the incentive structure."

The study, More than four in five office-based physicians could qualify for federal electronic health record initiatives, was authored by Brian K. Bruen, lead research scientist in the Department of Health Policy, School of Public Health and Health Services, at the George Washington University, in  Washington, D.C.; Leighton Ku, professsor in the Department of Health Policy, School of Public Health and Health Services, at the George Washington University; Matthew F. Burke, policy analyst in the Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, in Washington; and Melinda Beeuwkes Buntin, senior economic adviser in the Office of the National Coordinator for Health Information Technology.