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Horizontal and vertical integration's role in meaningful use attestation over time
Jordan Everson1, Michael R Richards2, Melinda B Buntin1
1Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
Health Services Research
|July 18, 2019
Summary
The Medicare Meaningful Use (MU) program saw higher attestation and lower attrition among integrated physicians compared to independent ones. This suggests the MU program may have widened the digital divide, potentially pressuring independent physicians to join larger organizations.
Area of Science:
- Health Informatics
- Health Services Research
- Physician Practice Patterns
Background:
- The Medicare Meaningful Use (MU) program aimed to incentivize the adoption of electronic health records (EHRs).
- Physician practice structures, including independent, horizontally integrated, and vertically integrated models, may influence technology adoption and program participation.
- Understanding disparities in MU program participation is crucial for evaluating its impact on healthcare delivery.
Purpose of the Study:
- To compare attestation and attrition rates from the MU program between independent and integrated physicians.
- To determine if the MU program created pressure for independent physicians to join integrated healthcare organizations.
Main Methods:
- Utilized secondary data from SK&A and Medicare MU Files (2011-2016) for office-based physicians across the United States.
- Compared MU attestation rates for physicians who remained independent or integrated throughout the study period.
- Employed multivariate regression models to assess the association between changes in physician integration status and MU attestation.
Main Results:
- Physicians remaining independent had a 49% MU attestation rate, compared to 70% for integrated physicians.
- Independent physicians exhibited significantly higher attrition rates from the MU program than integrated physicians.
- Physicians joining integrated organizations were more likely to have attested to MU prior to integration, with this trend strengthening post-integration.
Conclusions:
- The MU program may have exacerbated a digital divide between independent and integrated physicians.
- Disparities in MU program participation highlight potential inequities in EHR adoption and digital health advancement.
- Public policy interventions, such as enhanced regional extension centers, are recommended to address these observed disparities.