The $21 billion in incentives paid to acute care hospitals under the HITECH Act to get them to execute electronic health records (EHRs) systems was an important driver in their EHR adoption, and it wouldn’t have occurred without this investment by the federal government.
That is the conclusion of new research, published in the August issue of Health Affairs, which analyzed the differential effect of HITECH on EHR adoption among 4,268 incentive-eligible and 851 ineligible hospitals from the time period of 2008 to 2015.
The study discovered that annual increases in EHR adoption rates among eligible hospitals went from 3.2 percent in the pre-period (2008–10) to 14.2 percent in the post-period (2011–15) of implementation for the Act’s Meaningful Use incentive program. Only short-term acute care hospitals were eligible for the incentive payments.
At the similar time, ineligible hospitals faced much smaller annual increases of 0.1% in the pre-period and 3.3% in the post-period—a significant “difference-in-differences” of nearly eight percentage points for those that were eligible for the payments, compared with those that were not.
“That is the gained EHR adoption that you can attribute to HITECH,” claims Julia Adler-Milstein, associate professor at the University of Michigan’s School of Information and School of Public Health, who led the study.
In accordance with Adler-Milstein, some critics of the Meaningful Use program contend that hospitals might have adopted EHRs on their own without these incentives. Although, she believes the research she conducted with a colleague from Harvard University shows that the HITECH Act drove a key amount of EHR adoption among hospitals.
“If you look at the results by kind of hospital, what you see is that HITECH really shifted the needle on for-profit hospitals, which again I think is very consistent with this sense that hospitals weren’t investing in EHRs because they didn’t have the incentives to do so,” adds Adler-Milstein. “HITECH really changed that equation. These incentives were required to move the market.”
Inquired if the billions of dollars in incentives for hospitals was money well spent by the federal government, Adler-Milstein says that the value of this investment is in many respects in the eye of the beholder.
“I personally consider that, while it may not feel like money well spent right now—given the many issues with EHRs—it will a decade from now, as we continue to work to improve them,” she observes. “And, we will see HITECH as the catalyst that started the U.S. healthcare system’s IT transformation.”
Nevertheless, Adler-Milstein points out that not all hospitals were eligible for the incentive payments under HITECH, which she believes was a missed opportunity for them to benefit from EHRs.
“There is reason to consider that we should have extended this program to all hospitals,” she summarizes, adding that it was a limited resource decision. “I do not think that the architects of HITECH thought (that these other hospitals) don’t deserve the money or wouldn’t benefit from it. But there was a fixed pot of money and they had to make decisions. Now, looking back on it today, it does prove problematic, because we’ve this one group of hospitals that really has advanced in their EHR adoption, and this other group that really has not.”