In retrospect, we probably should have predicted that once Meaningful Use was put into place, some physicians would be better situated than others to take advantage of the program. Now, research has emerged to suggest that not only did MU create HIT winners and losers, it might also have helped to foster long-term differences between physicians who jumped in and those that didn’t.
The recently published research article, which focused on MU attestation, suggests that technology gaps may be opening between independent and health system-integrated physicians. It also concludes that MU may have created pressure on independent physicians to join integrated organizations.
The study, which appears in the journal Health Services Research, compared rates of MU attestation and attrition from the MU program among three groups: independent, horizontally integrated and vertically integrated physicians.
Researchers drew their data from both Medicare MU files for 2011 to 2016 covering US office-based physicians across the U.S. and healthcare data vendor SK&A. The data sample included 291,234 physicians.
The study found that 49% of physicians who stayed independent throughout the period attested to MU at least once during the program, while 70% of physicians who were horizontally or vertically integrated attested.
Of greater note was that only half or so of independent physicians who attested between 2011 and 2013 attested in 2015, a much different progression than that the researchers saw among integrated physicians. Also of note, physicians who joined integrated organizations were more likely to have attested to MU before they agreed to integrate.
In their discussion of the findings, the researchers argue that the data highlights a growing digital divide between independent physicians and those who integrate with larger organizations, which might possibly have been made worse by the MU program. They argue that public policy interventions such as new regional extension centers might be rolled out to help to minimize these differences.
The question is, is closing this digital divide the best way to invest public health IT dollars? The answer might seem like an obvious “yes” if you see the overall MU program as having been successful. However, but before we consider making such an investment, we’d probably want to re-examine our objectives.
My biggest objection to spending on addressing HIT disparities directly is that it assumes that our overarching goals are still the same, e.g. that EHR adoption is in and of itself good. For a variety of reasons, I’m not sure that such an assumption is warranted at this point. If we were to create a new round of regional extension centers, perhaps their mission should embrace ways in which high-end and low-end physician adopters differ beyond their access to capital. The issue is worth a look.