research-article

Business Benefits or Incentive Maximization? Impacts of the Medicare EHR Incentive Program at Acute Care Hospitals

Authors:

Anju HarpalaniAuthors Info & Claims

ACM Transactions on Management Information Systems (TMIS), Volume 4, Issue 4

Article No.: 20, Pages 1 - 19

https://doi.org/10.1145/2543900

Published: 01 December 2013 Publication History

Abstract

This study investigates the influence of the Medicare EHR Incentive Program on EHR adoption at acute care hospitals and the impact of EHR adoption on operational and financial efficiency/effectiveness. It finds that even before joining the incentive program, adopter hospitals had more efficient and effective Medicare operations than those of non-adopters. Adopters were also financially more efficient. After joining the program, adopter hospitals treated significantly more Medicare patients by shortening their stay durations, relative to their own non-Medicare patients and also to patients at non-adopter hospitals, even as their overall capacity utilization remained relatively unchanged. The study concludes that many of these hospitals had implemented EHR even before the initiation of the incentive program. It further infers that they joined this program with opportunistic intentions of tapping into incentive payouts which they maximized by taking on more Medicare patients. These findings give credence to critics of the program who have questioned its utility and alleged that it serves only to reward existing users of EHR technologies.

References

[1]

Angst, C. M. and Agarwal, R. 2009. Adoption of electronic health records in the presence of privacy concerns: The elaboration likelihood model and individual persuasion. MIS Quart. 33, 2, 339--370.

Digital Library

[2]

Anonymous. 2009. Lessons learned from a journey to EMR. Health Manag. Technol. 30, 11, 24--27.

[3]

Ayers, D. J., Menachemi, N., Ramamonjiarivelo, Z., Matthews, M., and Brooks, R. G. 2009. Adoption of electronic medical records: The role of network effects. J. Product Brand Manag. 18, 2, 127--135.

[4]

Blavin, F. E., Buntin, M. J., and Friedman, C. P. 2010. Alternative measures of electronic health record adoption among hospitals. Am. J. Manag. Care 16, 12, 293--301.

[5]

Charles, D., King, J., Patel, V., and Furukawa, M. F. 2013. Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008--2012. ONC Data Brief, No. 9. Washington, D.C.: Office of the National Coordinator for Health Information Technology.

[6]

DesRoches, C. M., Worzala, C., Joshi, M. S., Kralovec, P. D., and Jha, A. K. 2012. Small, nonteaching, and rural hospitals continue to be slow in adopting electronic health record systems. Health Affairs 31, 5, 1092--1099.

[7]

DiMaggio, P. and Powell, W. 1983. The iron cage revisited: Institutional isomorphism and collective rationality in organizational fields. Am. Sociol. Rev. 4, 2, 147--160.

[8]

East, T. D. 2005. The EHR paradox. Frontiers Health Serv. Manag. 22, 2, 33--35.

[9]

El-Gayar, O., Deokar, A. V., and Wills, M. J. 2010. Evaluating task-technology fit and user performance for an electronic health record system. Int. J. Healthcare Technol. Manag. 11, 1, 50--65.

[10]

Fareed, N., Ozcan, Y. A., and DeShazo, J. P. 2012. Hospital electronic medical record enterprise application strategies: Do they matter? Health Care Manag. Rev. 37, 1, 4--13.

[11]

Furukawa, M. F., Raghu, T. S., and Shao, B. B. M. 2010. Electronic medical records and cost efficiency in hospital medical-surgical units. Inquiry 47, 2, 110--123.

[12]

Ginn, G. O., Shen, J. J., and Moseley, C. B. 2011. Hospital financial position and the adoption of electronic health records. J. Healthcare Manage. 56, 5, 337--350.

[13]

Ginsburg, P. B. and Grossman, J. M. 2005. When the price isn’t right: How inadvertent payment incentives drive medical care. Health Affairs 24, W5, 376--384.

[14]

Hamelburg, M. 2009. EHR and HIT incentives in the American Recovery and Reinvestment Act. Intell. Property Technol. Law J. 21, 6, 7--13.

[15]

Helton, J. and Hsu, C. E. 2012. Do EHR investments lead to lower staffing levels? J. Healthcare Financial Manag. 66, 2, 54--60.

[16]

Hennington, A., Janz, B., Amis, J., and Nichols, E. 2009. Understanding the multidimensionality of information systems use: A study of nurses’ use of a mandated electronic medical record system. Commun. Assoc. Inform. Syst. 25, 1, 243--262.

[17]

Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., and Taylor, R. 2005. Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Affairs 24, 5, 1103--1117.

[18]

Hochstadt, B. and Keyt, D. 2009. Health care IT: Supporting cost efficiencies in tough times. Benefits Quart. 25, 4, 7--9.

[19]

Hoffmann, L. 2009. Implementing electronic medical records. Commun. ACM 52, 11, 18--20.

Digital Library

[20]

Jensen, T. B., Kjærgaard, A., and Svejvig, P. 2009. Using institutional theory with sensemaking theory: A case study of information system implementation in healthcare. J. Inform. Technol. 24, 4, 343--353.

[21]

Jha, A. K., Desroches, C. M., Campbell, E. G., Donelan, K., Rao, S. R., Ferris, T. G., Shields, A., Rosenbaum, S., and Blumenthal, D. 2009. Use of electronic health records in U.S. hospitals. New England J. Med. 360, 16, 1628--1638.

[22]

Kazley, A. S., Diana, M. L., and Menachemi, N. 2011. The agreement and internal consistency of national hospital EMR measures. Health Care Manag. Sci. 14, 4, 307--313.

[23]

Kazley, A. S., Diana, M. L., Ford, E. W., and Menachemi, N. 2012. Is electronic health record use associated with patient satisfaction in hospitals? Health Care Manage. Rev. 37, 1, 23--30.

[24]

Khoumbati, K. and Themistocleous, M. 2006. Evaluating integration approaches adopted by healthcare organizations. J. Comput. Inform. Syst. 47, 2, 20--27.

[25]

Kjerstad, E. 2003. Prospective funding of general hospitals in Norway: Incentives for higher production? Int. J. Health Care Finance Econ. 3, 4, 231--251.

[26]

MacKinnon, W. and Wasserman, M. 2009. Implementing electronic medical record systems. IT Prof. Mag. 11, 6, 50--53.

Digital Library

[27]

Mannion, R., Marini, G., and Street, A. 2008. Implementing payment by results in the English NHS. J. Health Org. Manag. 22, 1, 79--88.

[28]

Naylor, M. D., Kurtzman, E. T., Grabowski, D. C., Harrington, C., McClellan, M., and Reinhard, S. C. 2012. Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults. Health Affairs 31, 7, 1623--1632

[29]

Nov, O. and Schecter, W. 2012. Dispositional resistance to change and hospital physicians’ use of electronic medical records: A multidimensional perspective. J. Am. Soc. Inform. Sci. Technol. 63, 4, 648--656.

[30]

O’Reilly, J., Busse, R., Häkkinen, U., Or, Z., Street, A., and Wiley, M. 2012. Paying for hospital care: The experience with implementing activity-based funding in five European countries. Health Econ. Policy Law 7, 1, 73--101.

[31]

Pfeffer, J. and Salancik, G. R. 1978. The External Control of Organizations: A Resource Dependence Perspective. Stanford Business Books.

[32]

Rogers, W. H., Draper, D., Kahn, K. L., Keeler, E. B., Rubenstein, L. V., Kosecoff, J., and Brook, R. H. 1990. Quality of care before and after implementation of the DRG-based prospective payment system: A summary of effects. J. Am. Med. Assoc. 264, 15, 1989--1994.

[33]

Schumacher, R. M. and Jerch, K. E. 2012. Measuring usability in healthcare IT: It’s a practice, not a competition. Interactions 19, 4, 8--9.

Digital Library

[34]

Shin, D. Y., Menachemi, N., Diana, M., Kazley, A. S., Ford, E. W., and Allen, R. L. 2012. Payer mix and EHR adoption in hospitals. J. Healthcare Manag. 57, 6, 435--448.

[35]

Song, P. H., McAlearney, A. S., Robbins, J., McCullough, J. S., and Smith, B. T. 2011. Exploring the business case for ambulatory electronic health record system adoption. J. Healthcare Manag. 56, 3, 169--180.

[36]

Swanson, A. and Lind, S. 2011. Usability testing EHRs: Examples from the front lines. Interactions 18, 6, 54--58.

Digital Library

[37]

Terry, K. 2011. Are EHR incentives a waste of money? Informationweek. http://search.proquest.com/docview/899111609?.

[38]

Winston, E. R. and Medlin, B. D. 2011. Information technology implementation and adoption in relation to electronic medical records. J. Inform. Technol. Case Appl. Res. 13, 1, 43--59.

[39]

Wolf, L., Harvell, J., and Jha, A. K. 2012. Hospitals ineligible for federal meaningful-use incentives have dismally low rates of adoption of electronic health records. Health Affairs 31, 3, 505--513.

[40]

Zhivan, N. A. and Diana, M. L. 2012. U.S. hospital efficiency and adoption of health information technology. Health Care Manag. Sci. 15, 1, 37--47.

Cited By

Modi SFeldman SBerner ESchooley BJohnston A(2023)Value of Electronic Health Records: Measured using financial & clinical outcomes (Preprint)JMIR Medical Informatics10.2196/52524Online publication date: 6-Sep-2023
https://doi.org/10.2196/52524
Modi SFeldman S(2022)The Value of Electronic Health Records Since the Health Information Technology for Economic and Clinical Health Act: Systematic ReviewJMIR Medical Informatics10.2196/3728310:9(e37283)Online publication date: 27-Sep-2022
https://doi.org/10.2196/37283
Tiwari VTiwari B(2020)A Data Driven Multi-Layer Framework of Pervasive Information Computing System for eHealthcareInternational Journal of E-Health and Medical Communications10.4018/IJEHMC.201910010610:4(66-85)Online publication date: 1-Oct-2020
https://dl.acm.org/doi/10.4018/IJEHMC.2019100106
Show More Cited By

Index Terms

Business Benefits or Incentive Maximization? Impacts of the Medicare EHR Incentive Program at Acute Care Hospitals
1. Social and professional topics
  1. Computing / technology policy

Recommendations

Using Latent Class Analysis to Identify Sophistication Categories of Electronic Medical Record Systems in U.S. Acute Care Hospitals

Many believe that electronic medical record (EMR) systems hold promise for improving the quality of health care services. The body of research on this topic is still in the early stages, however, in part because of the challenge of measuring the ...
Experiences in mHealth for chronic disease management in 4 countries
ISABEL '11: Proceedings of the 4th International Symposium on Applied Sciences in Biomedical and Communication Technologies

This paper describes mHealth applications to deal with Non Communicable Diseases in North and Latin America: In Chile, a project focused on Diabetes Mellitus type 2; In the United States, Honduras, and Mexico, projects focused in diabetes, heart failure,...
EHR Implementation in a New Clinic: A Case Study of Clinician Perceptions

Driven by the Health Information Technology for Economic and Clinical Health (HITECH) Act large numbers of physicians and hospitals are now implementing electronic health records (EHR) with the general expectation that such systems will improve the ...

Comments

Information & Contributors

Information

Published In

cover image ACM Transactions on Management Information Systems

ACM Transactions on Management Information Systems Volume 4, Issue 4

Special Issue on Informatics for Smart Health and Wellbeing

December 2013

124 pages

ISSN:2158-656X

EISSN:2158-6578

DOI:10.1145/2555810

Editor:
Hsinchun Chen
University of Arizona

Issue’s Table of Contents

Copyright © 2013 ACM.

Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than the author(s) must be honored. Abstracting with credit is permitted. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request permissions from [email protected].

Publisher

Association for Computing Machinery

New York, NY, United States

Publication History

Published: 01 December 2013

Accepted: 01 November 2013

Revised: 01 October 2013

Received: 01 August 2012

Published in TMIS Volume 4, Issue 4

Permissions

Request permissions for this article.

Request Permissions

Check for updates

Author Tags

Qualifiers

Research-article
Research
Refereed

Contributors

Other Metrics

View Article Metrics

Bibliometrics & Citations

Bibliometrics

Article Metrics

7
Total Citations
View Citations
528
Total Downloads

Downloads (Last 12 months)9
Downloads (Last 6 weeks)2

Reflects downloads up to 15 Oct 2024

Other Metrics

View Author Metrics

Citations

Cited By

Modi SFeldman SBerner ESchooley BJohnston A(2023)Value of Electronic Health Records: Measured using financial & clinical outcomes (Preprint)JMIR Medical Informatics10.2196/52524Online publication date: 6-Sep-2023
https://doi.org/10.2196/52524
Modi SFeldman S(2022)The Value of Electronic Health Records Since the Health Information Technology for Economic and Clinical Health Act: Systematic ReviewJMIR Medical Informatics10.2196/3728310:9(e37283)Online publication date: 27-Sep-2022
https://doi.org/10.2196/37283
Tiwari VTiwari B(2020)A Data Driven Multi-Layer Framework of Pervasive Information Computing System for eHealthcareInternational Journal of E-Health and Medical Communications10.4018/IJEHMC.201910010610:4(66-85)Online publication date: 1-Oct-2020
https://dl.acm.org/doi/10.4018/IJEHMC.2019100106
Tiwari BTiwari V(2020)An Intelligent Multi-Objective Framework of Pervasive Information ComputingData Analytics in Medicine10.4018/978-1-7998-1204-3.ch025(456-469)Online publication date: 2020
https://doi.org/10.4018/978-1-7998-1204-3.ch025
Tiwari VThakur R(2019)An Extended Views Based Big Data Model Toward Facilitating Electronic Health Record AnalyticsTelemedicine Technologies10.1016/B978-0-12-816948-3.00013-1(193-199)Online publication date: 2019
https://doi.org/10.1016/B978-0-12-816948-3.00013-1
Tiwari BTiwari V(2018)An Intelligent Multi-Objective Framework of Pervasive Information ComputingInternational Journal of Healthcare Information Systems and Informatics10.4018/IJHISI.201810010213:4(15-27)Online publication date: 1-Oct-2018
https://dl.acm.org/doi/10.4018/IJHISI.2018100102
Saghafian SAustin GTraub S(undefined)Operations Research Contributions to Emergency Department Patient Flow Optimization: Review and Research ProspectsSSRN Electronic Journal10.2139/ssrn.2420163
https://doi.org/10.2139/ssrn.2420163

View Options

Get Access

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Full Access

Get this Article

View options

PDF

View or Download as a PDF file.

eReader

View online with eReader.

Media

Figures

Other

Tables

View Issue’s Table of Contents