Resumen de Physician Participation in Meaningful Use and Quality of Care for Medicare Fee-for-Service Enrollees

Hye Yeon Jung, Mark Aaron Unruh, Joshua R. Vest, Lawrence P. Casalino, Lisa M. Kern, Zachary M. Grinspan, Yuhua Bao, Rainu Kaushal

• Objectives The Meaningful Use initiative has made nearly $30 billion available through incentive programs to encourage provider adoption and use of electronic health records. The objective of this study was to evaluate the impact of outpatient physicians' participation in Meaningful Use on the quality of care provided to Medicare fee-for-service (FFS) enrollees.

  Design Retrospective cohort study.

  Setting One hundred percent inpatient and outpatient Medicare FFS claims covering the period January 2010 through December 2012.

  Participants 303,110 Medicare FFS enrollees from New York State.

  Measurements Hospitalizations and emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs), diabetic retinopathy screening, diabetic nephropathy screening, colorectal cancer screening, and influenza vaccinations.

  Results Physician participation in the Meaningful Use initiative was not associated with reductions in ACSC-related hospitalizations (0.0 percentage points, 95% confidence interval (CI): 0.0–0.1) or ED visits (0.0 percentage points, 95% CI: 0.0–0.1) relative to the comparison group. Meaningful Use participation was associated with higher odds of colorectal cancer screening (odds ratio (OR): 1.2, 95% CI: 1.1–1.4) relative to the comparison group, but not for diabetic retinopathy screening (OR: 1.1, 95% CI: 1.0–1.2), diabetic nephropathy screening (OR: 1.0, 95% CI: 0.8–1.2), or influenza vaccinations (OR: 1.1, 95% CI: 1.0–1.2). Similar results were found in secondary analyses of dually-eligible beneficiaries participating in both Medicare and Medicaid.

  Conclusion Physician participation in Meaningful Use was not associated with substantial improvements on six quality measures.