Health Affairs: Widespread EHR adoption gaps could influence policymakers

Source: Great Plains Regional Medical Center

Although the federal Medicare incentives will be available through 2016, and Medicaid incentives through 2021, widespread gaps in readiness throughout the states illustrate the challenges physicians face in meeting the federal schedule for the incentive programs, according to an article published in the April edition of Health Affairs.

Chun-Ju Hsiao, PhD, health services researcher at the Centers for Disease Control and Prevention’s National Center for Health Statistics, and colleagues found, using data from the 2011 mail survey supplement to the National Ambulatory Medical Care Survey, 91 percent of physicians were eligible for Medicare or Medicaid meaningful use incentives.

Approximately 85 percent of office-based physicians were eligible for Medicare meaningful-use incentives, and 18 percent for Medicaid incentives. “As more physicians adopt EHRs in their practices, policy interest is focusing on whether physicians are ready to meet the meaningful use criteria,” wrote the authors.

Their sample for national and state-specific analyses consisted of 3,996 physicians.

Fifty-one percent of all physicians intended to apply, according to the authors’ findings. “However, only 11 percent both intended to apply for the incentives and had EHRs with the capabilities to support even two-thirds of the Stage 1 core objectives required for meaningful use.”

Forty-one percent of physicians intended to apply but did not have these 10 core capabilities. Only about 14 percent of all physicians reported having the 10 capabilities. “Among physicians intending to apply, about 21 percent were ready with the 10 core capabilities,” they wrote. “Even in Wisconsin, the state with the highest percentage ready with those capabilities, only 32 percent of all physicians reported this degree of readiness.”

Older physicians were significantly less likely than younger ones to intend to apply for incentives. Physicians in practices with three or more physicians were more likely than those in solo or two-physician practices to intend to apply, as were physicians eligible for Medicare incentives compared to those who were not, Hsiao and company added.

Among those intending to apply for incentives, practices with 11 physicians or more were 14 percentage points more likely to have the needed 10 computerized capabilities than physicians in solo or two-physician practices, they found, noting physicians in practices not owned by a physician or physician group were about 11 percentage points more likely to have these capabilities than physicians in practices that were owned by a physician or physician group. “Being eligible for Medicaid incentives or being in nonprimary care specialties made it less likely that practices would have the capabilities.”

According to the authors, investigating the reasons for differences in readiness and in intention to apply for incentives across states is an important topic for future research. “It is likely that no one single variable explains these differences.”

The researchers concluded they hoped their research would assist policymakers target efforts to improve EHRs’ adoption and use.