Association between Electronic Health Records Meaningful Use Attestation and Medicare Spending per Beneficiary among US Hospitals

摘要

Objective: Evidence that the Electronic Health Records (EHRs) system improves care quality and cost efficiency was inconclusive. We examined the association between EHR implementation and hospital cost efficiency.;Measurement: We used Meaningful Use Attestation Stage (MU stage) to represent the EHR adoption level of hospitals. Hospital efficiency was measured by Medicare spending per beneficiary (MSPB) scores---a ratio of risk-adjusted hospital MSPB amount to national median MSPB amount across all hospitals.;Study design: Secondary data are from the CMS (Hospital Compare and EHR Incentive Programs) which include 3051 hospitals nationwide data from 2012 to 2016. We examined the heterogeneous relationship between the stage level of Meaningful Use Attestation (MU stage) and hospital Medicare spending per beneficiary (MSPB) scores at thousands of US hospitals nationwide between 2012 and 2016. The ownership status and bed number of hospitals were used as hospital characteristics. Hospital Retrospective difference-in-difference model in an interrupted time series approach was employed to examine the change of cost efficiency of entering MU stage.;Results: 1)The MU stage status distribution of US hospitals became more polarization during the study period. (only 1.07 percent hospitals be in MU stage 1 at 2016, while 49,4 percent without MU stage status and 49.5 entered MU Stage) 2) Hospital ownership was similar across hospitals with distinct MU stages. Bed number, on the other hand, was significantly difference by MU stage status, where higher MU stage hospitals were more likely to have more bed number (p<0.0001). Hospitals with 50 to 300 beds were more likely to remain in the status without meeting MU stage requirements. And the hospitals with more than 300 beds were more likely to meet MU stage requirements, for 60.91% of second group and 58.71% for third group hospitals have more than 300 beds, compared to 27.73% of first group. Hospitals with more bed numbers are more likely to entering higher MU stage. 3) After analyze the standard error and 95% CI of the MSPB score, there was no statistically significant difference between the MSPB scores of hospitals before and after entering MU stage.;Conclusions: 1) The MU stage status distribution of US hospitals became more polarized during the study period. 2) Hospital ownership was similar across hospitals with distinct MU stages. Bed number, on the other hand, was significantly difference by MU stage status, where higher MU stage hospitals were more likely to have more bed number (p<0.0001). 3)MU stage status of hospitals wasn't significantly associated hospitals' MSPB scores in the study period.