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MACRA Incentives Likely to Increase Physician Health IT Use

A new study at the University of California shows financial incentives stimulate HIT adoption, specifically in smaller practices.

By Kate Monica

Future financial support as part of MACRA implementation will have a positive effect on small practice health IT adoption and use, according to new research published in the Annals of Family Medicine.

That conclusion is the result of a study of health IT adoption and use among small primary care physician practices by a team of researchers from the University of California Department of Family and Community and Weill Cornell Medical College.

To complete the survey, researchers reviewed data from a 40-minute telephone panel survey of 566 small primary care practices with 8 or fewer physicians to investigate physician health IT adoption and use between two periods: 2007-2010 and 2012-2013.

The study included 18 measures of health IT functionalities ranging from electronic record keeping to health information exchange with hospitals and pharmacies.

Of these 18 HIT functionalities, researchers concluded 16 functionalities showed an overall increase in use, including use of EHR technology to collect clinical quality data and use of patient-oriented functionalities (e.g., patients accessing their online medical record). Researchers noted the two functionalities that did not show an increase in use were adoption of chronic disease registries for congestive heart failure and depression and electronic access to laboratory results.

Researchers found participation in electronic public reporting of data and pay-for-performance incentives increased health IT adoption and use over time. The share of practices earning more than 35% of their revenue from Medicare also showed an uptick in health IT adoption and use over the duration of the study.

Additionally, the number of physicians reporting they did not have EHR technology and were still reliant on paper records declined from 66.8 percent to 32.3 percent. Physician EHR use to collect clinical quality data increased from 17 percent to 42 percent among the surveyed practices, and e-prescribing rose from 25 percent to 70 percent by its conclusion of the study.

Of particular interest given that the Quality Payment Program under MACRA is now underway is the correlation between external incentives and physician health IT implementation and adoption.

Researchers determined financial incentives significantly demonstrated a positive effect on physician health IT adoption and use.  Specifically, Rittenhouse et al. concluded that smaller and privately-owned physician practices are more likely to benefit from external incentives in adopting HIT.

External incentives include participation in public reporting of clinical quality, participation in pay-for-performance programs, and revenue obtained through Medicare reimbursement.

Achieving EHR and health IT adoption has been a long road for small practices and physician-owned facilities.

“The majority of primary care practices in the United States are small, and many have taken on the enormous challenge of transforming how they deliver care. Implementation and meaningful use of HIT serves as an important aspect of practice transformation and a foundational element for high-performing primary care,” noted the authors of the study.

Since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) in 2010, the federal government has taken steps to promote health IT adoption among Medicare providers, most notably through the $30 billion dedicated to the EHR Incentive Programs.

Similarly, the Office of the National Coordinator (ONC) established a nationwide system of regional extension centers with the goal of supporting physician EHR adoption by small primary care practices and advanced interoperability across the United States. Despite these efforts, nationwide interoperability remains a goal rather a reality.

A new wave of payment adjustments as part of the Quality Payment Program and MACRA implementation are expected to build on that foundation of physician adoption and use.

“Little is known about how exactly these new [MACRA] payment systems will shape up, but our study findings demonstrate that both practice characteristics and external incentives for change are important correlates of HIT adoption and use over time,” Rittenhouse et al. concluded.

Dig Deeper:
What is MACRA and What It Means to Providers, EHR Technology
What is EHR Optimization, How Does It Start?




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