Eligibility for financial incentives and electronic medical record use among physicians.

Chang Liu, MA, Rosa Baier, MPH, Rebekah Gardner, MD, and Amal Trivedi, MD, MPH  although elecTronic medical recordS (EMRs) may improve quality of care and reduce healthcare spending, uptake remains low in the United States. 8 A 2009 national survey of hospitals found that only 2.9% of hospitals had a comprehensive, electronic system and an additional 7.9%, a basic system. The same year, a physician-level study found that 43.9% of physicians were using basic EMRs, though only a subset, 6.3% of physicians, had a fully-functional system. Interestingly, physicians cite costs as both the most important barrier and financial incentives as the most important facilitator of EMR adoption. 11, 12 Although some published research casts doubt on the impact of financial incentives on healthcare quality improvement initiatives, studies have shown that financial incentives are key to EMR adoption. 11 For physicians, incentives address a fundamental imbalance, where physicians assume the costs of EMR implementation and maintenance, yet nearly all the financial benefits accrue to payers and purchasers. This misalignment has prompted calls for greater financial support from payers and regulators. However, to our knowledge, no peer-reviewed study has assessed the effectiveness of financial incentives on EMR adoption and use. Recognizing the significant role of financial incentives in accelerating EMR adoption, the Federal American Recovery and Reinvestment Act (ARRA) of 2009 provides $20 billion in Medicare and Medicaid incentive payments to physicians and hospitals whose use of certified EMRs meets a minimum set of requirements (“meaningful use”). State government and commercial health plans are also engaged in local efforts to provide incentives (financial and nonfinancial) for physicians to purchase and use EMRs. As the first and only state to systematically assess and publicly report EMR adoption for every licensed physician providing direct patient care, Rhode Island provides an opportunity to assess the relationship between eligibility for financial incentives and EMR adoption. Blue Cross & Blue Shield of Rhode Island (BCBSRI) and UnitedHealthcare of New England (UHC), the state’s two largest commercial health plans representing 96% of the non-elderly, commercial market, began offering EMR-based payments to office-based primary care physicians (PCPs) in 2008 and 2009, respectively. BCBSRI increased primary reimbursements for all evaluation and management services by 5% to 13% and UHC offered fixed-sum payments for office-based PCPs with EMRs meeting pre-specified standards. We hypothesize that these efforts may be associated with greater EMR adoption than the rates reported in national studies, particularly among those office-based PCPs eligible for the health plans’ payments. We therefore evaluated the association between physician specialty, practice site, and EMR adoption. Using the state’s comprehensive survey, we assessed EMR implementation and functionality use among Rhode Island physicians after the initiation of health plan incentive payments.