Is duration of hospital participation in meaningful use associated with value in Medicare?

"Meaningful Use" (MU) of electronic health records (EHRs) is a measure used by Medicare to determine whether hospitals are comprehensively using electronic tools. Whether hospitals' engagement in value-based initiatives such as MU is associated with value-defined as high quality and low costs-is unknown. Our objectives were to describe hospital participation in MU, and determine whether duration of participation is associated with value.

We linked national Medicare data with MU and other hospital-level and market data. We analyzed bivariate relationships to characterize duration of participation. We estimated inverse probability-weighted multilevel logistic regressions to evaluate whether duration of participation was associated with higher likelihood of value-operationalized as having performance on 30-day readmission and inpatient spending at or below the national average.

Of 2860 short-term hospitals, 59% had 4 or 5 years of MU participation by 2015; 7% had 1 or 2 years. There were differences by duration of participation across location, ownership, and size. Seventeen percent of hospitals were classified as high-value. Controlling for hospital characteristics, and holding constant market location, there was no evidence of a statistical association between duration of participation and value (odds ratio = 1.05, 95% confidence interval: 0.91-1.21; P = .51). Examining the 2 outcomes separately, there was a significant relationship between duration of participation and lower Medicare inpatient spending, but not 30-day readmission.

Sustained participation in MU is associated with lower Medicare spending, but not with lower readmission rates.

Policy interventions aimed at increasing value may need a broader focus than EHR implementation and use.