Business Benefits or Incentive Maximization? Impacts of the Medicare EHR Incentive Program at Acute Care Hospitals

Abstract

This study investigates the influence of the Medicare EHR Incentive Program on EHR adoption at acute care hospitals and the impact of EHR adoption on operational and financial efficiency/effectiveness. It finds that even before joining the incentive program, adopter hospitals had more efficient and effective Medicare operations than those of non-adopters. Adopters were also financially more efficient. After joining the program, adopter hospitals treated significantly more Medicare patients by shortening their stay durations, relative to their own non-Medicare patients and also to patients at non-adopter hospitals, even as their overall capacity utilization remained relatively unchanged. The study concludes that many of these hospitals had implemented EHR even before the initiation of the incentive program. It further infers that they joined this program with opportunistic intentions of tapping into incentive payouts which they maximized by taking on more Medicare patients. These findings give credence to critics of the program who have questioned its utility and alleged that it serves only to reward existing users of EHR technologies.

The Value of Electronic Health Records Since the Health Information Technology for Economic and Clinical Health Act: Systematic Review

“…Dandu et al [ 41 ] did not provide any statistically significant evidence to report a direct association between EHR adoption and higher-level billing [ 41 ]. Similarly, Mirani and Harpalani [ 27 ] did not provide any statistically significant evidence to report a direct association between EHR adoption and revenue. Findings from Collum et al [ 8 ] suggested that alterations in the level of EHR adoption were not related to increases in revenue and the reduction of operating margins.…”

“…Of the 58 reviewed studies, 55 (95%) contained segments that were coded under the category of “Value-Clinical Outcomes.” The differing measures for clinical outcomes in these studies were productivity [ 26 , 28 , 30 ], workflow inefficiency, medical errors, patient safety [ 3 ], patient satisfaction, clinical volume, readmission rates, patient LOS [ 27 ], and quality indicators at the individual patient level. The different measures of clinical outcomes are listed and described in depth in Table 2 .…”

“…Of the 58 studies in this review of the literature, 5 (9%) studies highlighted the intersection of financial and clinical outcomes. EHR adoption allowed for improvements in clinical documentation time and LOS and sequentially reduced overall costs and improved reimbursement [ 27 , 30 , 42 , 66 ]. EHR adoption was also responsible for an increase in personnel costs in association with the new technology’s initial steep learning curve [ 67 ].…”

“…Of the 58 studies reviewed, 21 (36%) studies incorporated segments that were coded under the "Value-Financial Outcomes" category. Different measures of financial outcomes were used in these studies, such as cost [26][27][28][29], revenue [28,29], profit margins [8,27], reimbursement [30], and return on assets [8]. These different financial outcome measures are described and detailed in Table 2.…”

Role-based access control through on-demand classification of electronic health record

“…Protection of medical records becomes more important in cases where disclosure of personal medical information may create an embarrassing situation for patients or causes discrimination based on medical ailment (I v Finland, 2008;Jin et al, 2011). Boasted benefits of EHR include seamless information availability and exchange, fewer medical errors, drug compliance, patient and physician satisfaction, lowered healthcare prices, as well as improved quality of clinical issues (Mirani and Harpalani, 2013). It is estimated that during a typical hospital stay, about 150 people such as doctors, nurses, X-ray technicians and billing clerks can access patient's medical records to perform their duties (Charette, 2006).…”