Barriers to Meaningful Use in Medicaid (Text Version)

Slide presentation from the AHRQ 2011 conference.

On September 19, 2011, Linda Dimitropoulos made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (700 KB). Plugin Software Help.


Slide 1

 Barriers to Meaningful Use in Medicaid

Barriers to Meaningful Use in Medicaid

2011 AHRQ Annual Conference
September 19, 2011

Presented by:

Heather Johnson-Skrivanek, AHRQ
Linda Dimitropoulos, Chuck Thompson, Stephanie Kissam, Alison Banger, RTI International

Funded by the Agency for Healthcare Research and Quality

Slide 2

 Session Objectives

Session Objectives

  • Provide background and impetus for studying the barriers to meaningful use of EHRs among Medicaid providers.
  • Summarize prior research.
  • Lead an interactive discussion of barriers, and policy and technical assistance solutions.
  • Discuss next steps for the project.

Slide 3

 Motivation for Study of Barriers to Meaningful Use in Medicaid

Motivation for Study of Barriers to Meaningful Use in Medicaid

  • Differences in Medicare and Medicaid populations; EHR incentive programs.
 MedicareMedicaid
Population

Generally people age 65 and older

People under 65 who are disabled

No income requirements

50% children, 25% age 18-64, 15% age 18-64 with disability, 10% age 65 and older

Low income

Eligible professionalsMD, DO, Optometry, Podiatry, Dental Surgery or MedicineSee next slide
Time period5 years6 years
Incentive amountTied to Medicare allowable charges; maximum amount $44,000 over 5 yearsPayment from State; maximum amount $63,750 over 6 years

Slide 4

Medicaid Eligible Professionals (EPs)

Medicaid Eligible Professionals (EPs)

  • EPs, private practice:
    • Physicians, pediatricians, dentists, certified nurse-midwives, nurse practitioners.
    • Minimum 30% Medicaid patients (20% for pediatricians).
  • EPs, Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs):
    • All of the above, plus physician assistants who lead those centers.
    • Minimum 30% Medicaid patients or "needy individuals" (includes CHIP) (20% for pediatricians).

Slide 5

Influences on Medicaid providers' ability to demonstrate meaningful use of EHRs

Influences on Medicaid providers' ability to demonstrate meaningful use of EHRs

An image showing Influences on Medicaid providers' ability to demonstrate meaningful use of EHRs is shown.

Slide 6

Prior research

Prior research

  • What was EHR adoption rate among Medicaid providers prior to CMS EHR Incentive Program?
    • First national survey of EHR use in Community Health Centers (CHCs):
      • 26% reported some EHR capacity.
      • 13% have an EHR with a minimum set of functionalities (Shields et al., 2007).
    • Survey of pediatricians: 21% had an EHR (Kemper et al., 2006).
    • No prior definition of a "Medicaid provider": scant research available on professionals in private practice.

Slide 7

Prior research

Prior research

  • What is known about facilitators and barriers of EHR use among Medicaid providers?
    • Facilitators for CHCs.
      • Internal IT support (Bramble et al., 2010).
      • Participation in a Health Center Controlled Network (Egleson et al., 2010).
    • For general providers, larger-sized practices more likely to adopt and use EHRs (Simon et al., 2008; Hing and Burt, 2009; Kemper et al., 2006).

Slide 8

Hypothesized Barriers

Hypothesized Barriers

  • To eligibility:
  • Unsure of Medicaid patient volumes.
  • To adoption, implementation, or upgrade.
  • Lack of capital (Shields et al., 2007; Kemper et al., 2006).
  • No availability of EHRs for Medicaid populations / dentists.
  • Few or no technical assistance resources.

Slide 9

Hypothesized Barriers

Hypothesized Barriers

  • To achieving meaningful use:
  • Difficulty in achieving Meaningful Use criteria themselves, such as clinical quality measures (CQMs) or core EHR functions.
  • Lack of IT support at practice.
  • Criteria (e.g., some CQMs) seen as not appropriate to Medicaid providers such as pediatricians, dentists, and nurse mid-wives.

Slide 10

Small Group Discussion: Barriers to Meaningful Use

Small Group Discussion: Barriers to Meaningful Use

  • What other barriers might exist for Medicaid providers attempting to achieve Meaningful Use?
  • Please add any additional barriers to the notes sheet for your group.

Slide 11

Small Group Discussion: Policy Solutions and Technical Assistance

Small Group Discussion: Policy Solutions and Technical Assistance

  • Discuss potential solutions for each identified barrier.
  • Solutions may be:
    • Policy solutions (regulatory).
    • Technical assistance from Federal/State government?
    • Actions by other stakeholders?
    • Other?
  • Add solutions to the notes sheet.

Slide 12

Next Steps for AHRQ / RTI

Next Steps for AHRQ / RTI

  • Conduct focus groups in California, Louisiana, New York, and Tennessee.
  • Conduct virtual focus groups.
  • Analyze findings.
  • Report to inform:
    • Outreach and assistance to Medicaid providers.
    • Future Meaningful Use regulations.

Slide 13

References

References

  • Bramble JD, Galt KA, Siracuse MV, Abbott AA, Drincic A, Paschal KA, Fuji KT. The relationship between physician practice characteristics and physician adoption of electronic health records. Health Care Manage Rev 2010 Jan-Mar; 35(1):55-64.
  • DesRoches, CM et al (2008) Electronic health records in ambulatory care—a national survey of physicians," NEJM 359:1.
  • Egleson N, Kang JH, Collymore D, Esmond W, Gonzalez L, Pong P, Sherman L. A health center controlled network's experience in ambulatory care EHR implementation. J Healthc Inf Manag 2010 Spring; 24(2):28-33.
  • Hing E, Burt CW. Are there patient disparities when electronic health records are adopted? J Health Care Poor Underserved 2009 May; 20(2):473-88.
  • Kemper AR, Uren RL, Clark SJ. Adoption of Electronic Health Records in Primary Care Pediatric Practices. Pediatrics 2006 July; 118(1):e20-e24.
  • Shields AE, Shin P, Leu MG, Levy DE, Betancourt RM, Hawkins D, Proser M. Adoption of health information technology in community health centers: results of a national survey. Health Aff (Millwood) 2007 Sep-Oct; 26(5):1373-83.
  • Simon, S.R., et al., Electronic health records: which practices have them, and how are clinicians using them? J Eval Clin Pract 2008. 14(1): p. 43-7.
Current as of March 2012
Internet Citation: Barriers to Meaningful Use in Medicaid (Text Version). March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/dimitropoulos/index.html