MU program widened gap between private, group practices
There is a growing digital divide between doctors who remain independent and integrated delivery system physicians that may have been exacerbated by the Meaningful Use program.
That’s the conclusion of a new study by researchers who assessed the difference in electronic health records usage among more than 291,000 doctors and found challenges faced by independent practices in adopting new and costly EHRs.
The study of office‐based physicians in all 50 states and the District of Columbia leveraged 2011‐2016 secondary data from SK&A and Medicare MU files.
Investigators compared attestation rates among doctors that remained independent or integrated throughout the study period and then evaluated the association between changing integration and MU attestation in multivariate regression models.
“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,” state the study’s authors. “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.”
While about half of independent doctors who participated in the MU program between 2011 and 2013 left the program by 2015; during that same time period, fewer than 20 percent of physicians who worked for hospitals left the program.
Further, in multivariate regression models, researchers discovered that doctors that “joined these organizations were more likely to have attested to MU prior to integrating and this difference increased following integration.”
According to lead author Jordan Everson, assistant professor in the Department of Health Policy at Vanderbilt University Medical Center, one way the data can be interpreted is that independent doctors have more authority over the technology they use and could simply choose not to continue in the program, as opposed to doctors in integrated systems where management could require participation.
“Another way to interpret this is that the cost-benefit equation was worse for independent physicians,” says Everson. “In other words, the financial incentives in later years were not enough to overcome the cost of keeping up with Meaningful Use in addition to the time burden of using EHRs. Financial costs are likely particularly high for independent physicians who can't spread the cost across a large organization.”
At the same time, although the ongoing trend is that doctors have been entering into larger, integrated health practices, physicians who haven’t kept up with EHR technology could be limited in their ability to make that transition. For instance, the study revealed that independent physicians who participated in MU on their own were more likely to later join integrated systems than doctors who did not participate in the program.
“That may mean that physicians who are not technologically savvy do not have the option to join a bigger system to get help with new technologies,” added Everson.