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Abstract

This was a retrospective cohort study of ambulatory care quality by physicians who received payment for Medicaid Stage 1 Meaningful Use (MU) in 2012 using New York State Medicaid Claims (2010-2013). Eight quality measures were used to compare performance of physicians who received payments to Adopt, Implement, or Use (AIU) an electronic health record in 2011 but not for MU in 2012 (AIU-only group) and physicians who cared for Medicaid patients but received no payments (no-incentive group), using propensity score-weighted difference-in-difference logistic regression analyses, clustering by physician. In all, 13 697 physicians and 913 476 patients were studied. In 2010, the MU group scored higher than both groups (vs AIU-only in 3 of 8 measures, 0.8-1.3 adjusted percentage points; vs no-incentive, 2 of 8 measures, 0.9-2.0 adjusted percentage points). The difference-in-difference analysis found no additional improvements in quality over time relative to either control group. Longer follow-up is needed to determine the effects of Stage 2 MU.

Keywords

meaningful use quality Medicaid electronic health records New York

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References

The Henry J Kaiser Family Foundation. Total monthly Medicaid and CHIP enrollment. http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/. Accessed April 8, 2015.

Chaudhry

Wang

et al . Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006;144:742-752.

Poon

Wright

Simon

et al . Relationship between use of electronic health record features and health care quality: results of a statewide survey. Med Care. 2010;48:203-209.

Reed

Huang

Graetz

et al . Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus. Ann Intern Med. 2012;157:482-489.

Kern

Barron

Dhopeshwarkar

Edwards

Kaushal

; HITECH Investigators. Electronic health records and ambulatory quality of care. J Gen Intern Med. 2013;28:496-503.

Kern

Edwards

Pichardo

Kaushal

Electronic health records and health care quality over time in a federally qualified health center. J Am Med Inform Assoc. 2015;22:453-458.

Frimpong

Jackson

Stewart

Singh

Rivers

Bae

Health information technology capacity at federally qualified health centers: a mechanism for improving quality of care. BMC Health Serv Res. 2013;13:35.

Blumenthal

Tavenner

The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363:501-504.

Blumenthal

Launching HITECH. N Engl J Med. 2010;362:382-385.

10.

Slavitt

DeSalvo

Moving toward improved care through information. https://blog.cms.gov/2016/04/27/moving-toward-improved-care-through-information/. Accessed July 12, 2016.

11.

Kern

Silver

Kaushal

; HITECH Investigators. State funding for health information technology and selected ambulatory healthcare quality measures. Appl Clin Inform. 2014;5:594-602.

12.

Samal

Wright

Healey

Linder

Bates

DW.

Meaningful use and quality of care. JAMA Intern Med. 2014;174:997-998.

13.

Kern

Edwards

Kaushal

; HITECH Investigators. The meaningful use of electronic health records and health care quality. Am J Med Qual. 2015;6:512-519.

14.

Jung

Unruh

Kaushal

Vest

JR.

Growth of New York physician participation in meaningful use of electronic health records was variable, 2011-12. Health Aff (Millwood). 2015;34:1035-1043.

15.

The Johns Hopkins University. The Johns Hopkins ACG system. http://acg.jhsph.org/. Accessed March 20, 2015.

16.

Imbens

GW.

Nonparametric estimation of average treatment effect under exogeneity: a review. Rev Econ Stat. 2004;86:4-29.

17.

Austin

PC.

An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46:399-424.

18.

Mehrotra

Adams

Thomas

McGlynn

EA.

The impact of different attribution rules on individual physician cost profiles. Ann Intern Med. 2010;152:649-654.

19.

R: A Language and Environment for Statistical Computing [computer program]. Vienna, Austria: R Foundation for Statistical Computing; 2011.

20.

data.table: Extension of data.frame for Fast Indexing, Fast Ordered Joins, Fast Assignment, Fast Grouping and List Columns [computer program]. R package version 1.8.6. Vienna, Austria: R Foundation for Statistical Computing; 2012.

21.

Fox

Weisberg

Fox

An R Companion to Applied Regression. 2nd ed. Thousand Oaks, CA: Sage; 2011.

22.

Lumley

Complex Surveys: A Guide to Analysis Using R. Hoboken, NJ: John Wiley; 2010.

23.

Wickham

ggplot2: Elegant Graphics for Data Analysis. New York, NY: Springer; 2009.

24.

Hsiao

C-J

Hing

Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001–2013. http://www.cdc.gov/nchs/data/databriefs/db143.pdf. Accessed August 5, 2015.

25.

Middleton

Bloomrosen

Dente

et al . Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc. 2013;20(e1):e2-e8.

26.

Centers for Medicare and Medicaid Services. Merit-based incentive payment system: advancing care information. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Advancing-Care-Information-Fact-Sheet.pdf. Accessed July 12, 2016.

27.

Kern

Barron

Abramson

Patel

Kaushal

HEAL NY: promoting interoperable health information technology in New York State. Health Aff (Millwood). 2009;28:493-504.

28.

Henry

Kaiser Family Foundation. Medicaid spending per enrollee (full or partial benefit). Timeframe: FY2011. http://kff.org/medicaid/state-indicator/medicaid-spending-per-enrollee/. Accessed February 20, 2015.

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Medicaid Stage 1 Meaningful Use EHR Incentive Payments Are Associated With Higher Quality but Not Improvements in Quality

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