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Few FL Medicaid Docs Stuck With Meaningful Use Attestation

After receiving the first-year meaningful use EHR incentives, most Florida Medicaid providers dropped out of the program.

Between 2011 and 2018, the state of Florida distributed nearly $100 million to healthcare providers that eventually did not maintain meaningful use status after obtaining first-year financial incentives, according to a study published in the International Journal of Medical Informatics. Only 43 percent of Florida Medicaid providers achieved meaningful use after receiving the first-year incentive.

Numerous studies have found the HITECH ACT to be directly responsible for the significant increase in provider EHR adoption rates. Incentivizing EHR adoption was based partially on the premise that EHRs would enhance patient safety and healthcare quality. 

Florida Atlantic University researchers aimed to assess provider participation beyond the initial incentive of up to nearly $22,000.

Following the initial incentive in State 1 Meaningful Use, healthcare providers were eligible receive upwards of $8,500 annually if they participated in the remaining five years of that program. Such participation in Stages 2 and 3 Meaningful Use would entail utilizing certified EHR or health IT to improve care quality, patient safety, and clinician efficiency.

The researchers leveraged nearly 9,000 records between 2011 to 2018 from the Florida Medicaid Promoting Interoperability program, which is what the now-defunct meaningful use program turned into. Research showed 43 percent of providers achieved meaningful use after receiving the first-year incentive payments, which was a 40 percent decrease after the first year.

Thus, the providers were unable to receive health IT assistance.

“The study was significant for many reasons,” Pierre K. Alexandre, PhD, associate professor and director of management programs in the College of Business’ Health Administration department, said in a statement. “It tells you that the incentive program, although it had the best of intentions, may not have done enough for certain providers to make it worth continuing in the program.”

Of the Florida providers who did stick with meaningful use, 65 percent were pediatricians, 43 came from group practices, and 42 percent came from solo physician practices.

The data also revealed a rural-urban divide, with 58 percent of rural Florida providers achieving meaningful use, compared to 42 percent of urban area providers.

“So about six out of 10 Florida Medicaid providers have basic EHR systems that cannot function in ways that can positively impact patient care,” said Judith P. Monestime, FAU College of Business professor and the lead study author.

The study authors noted Florida Medicaid meaningful use achievement rate of 43 percent is 13 percentage points below the national Medicaid meaningful use rate of 56 percent.

Medicaid providers who did not achieve meaningful use after the first year did not receive punishment after collecting the first-year payment, the study authors wrote. Thus, providers in the Medicaid program could have less motivation to maintain the status after the first year.

Most healthcare experts agree that what some clinicians called the onerous reporting requirements for meaningful use, and now Promoting Interoperability, discouraged them from participation. Clinicians would rather forego the incentive payments than fulfill meaningful use participation.

Nearly 60 percent of Medicaid providers withdrew meaningful use participation after receiving the initial first-year payment, the research team said.

“This is concerning because advanced EHR functions – such as Meaningful Use – are necessary precursors to address unmet socioeconomic needs to reduce health disparities,” Monestime added. “Not meeting these needs leads to higher healthcare costs fueled by a cycle of emergency room readmissions.”

While the HITECH Act successfully promoted the adoption of a basic EHR system, low meaningful use attestations inadvertently created a digital “advanced use” divide among Medicaid providers, the study authors added.

“Ultimately, efforts to improve health outcomes, reduce costs, and increase health equity for underserved populations through advanced EHR functions have stalled,” the study authors concluded. “These results may provide timely information on the merits of further legislative efforts to increase MU and promote health information exchange.”

The study authors suggested the different eligibility requirements for lower volume based on the range of practice, such as pediatricians, could promote equity in program participation among dentists.

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