EHR disparity between Medicaid, Medicare MU docs unacceptable

The unintended creation of disparities caused by the Meaningful Use program has reached a new low.

This time, we're learning from a study conducted in part by a health analyst from the Office of the National Coordinator for Health IT that there's a big discrepancy between physicians participating in the Medicare Meaningful Use Program and those on the Medicaid side. The program, recognizing that eligible professionals participating in the Medicaid incentive program may have resource challenges, was designed to allow those physicians to receive an incentive payment in the first year of participating simply for adopting, implementing or updating their EHR technology without having to attest to Meaningful Use. This was effective; a "strong majority" of them did so and received incentive payments.

However, the doctors in these "resource constrained settings" had a much lower likelihood of actually achieving Meaningful Use after that. Only one-third of the physicians registered in the Medicaid incentive program had successfully attested in 2013, compared to eight of 10 physicians registered in the Medicare incentive program. The researchers surmised that, among other things, the doctors in the Medicaid program incurred additional and/or significant barriers to Meaningful Use.  

The report is sobering, but unfortunately not surprising. We've already seen that the Meaningful Use program and health IT are creating a digital divide.

It's happening with patients. White, more affluent and educated consumers are more likely to be offered online access to their records and actually review them. They're also more likely to use other health IT resources, like email, to contact their doctors.

It's happening with other provider types. Lower resource institutional providers and those that serve the poor are less likely to adopt and successfully use EHRs. For example, the Centers for Medicare & Medicaid Services reported in 2013 that while 70 percent of community health centers, which typically treat the uninsured and those on Medicaid, had adopted some type of EHR, only 9 percent have achieved Meaningful Use, despite support from a regional extension center (REC).

It's happening between physicians and hospitals. The Medicare Access and CHIP Reauthorization Act (MACRA) shifts the physicians in the Medicare Meaningful Use program into the newly created Merit Based Incentive Program System (MIPS). We know that this does not eliminate the Meaningful Use program, since hospitals will still be a part of it. But if the programs are not aligned, it will likely drive hospitals and doctors apart. This concern has been raised by both the American Hospital Association (AHA) and the College of Healthcare Information Management Executives (CHIME) in testimony about how MIPS should be structured.

Now, it's even between doctors participating in Meaningful Use. Participate in in the Medicaid program, and chances are you'll lag behind your Medicare-participating peers.

And it's about to get worse: While the AHA and CHIME didn't mention it, the truth is that the Medicaid doctors are in the same boat as the hospitals, since they also remain in the Meaningful Use program, while the Medicare docs move into MIPS. The Medicaid doctors have to deal with a program that many have called outdated and overly burdensome; the Medicare doctors get to try a brand new and shiny program.

It's bad enough that there's a digital divide. But it's really bad when it affects physicians, whose major difference is not their training, experience or perhaps even their willingness to use EHRs, but rather the nature of the patients that they treat and the kind of insurance that those patients possess.

This could have ripple effects far beyond the Meaningful Use program and health IT itself, as we move from electronic disparities to health disparities. This can impact patient care, care coordination, the cost of healthcare and population health.

And all of this leaves the most vulnerable patients even more unprotected.

That's just not right. - Marla (@MarlaHirsch and @FierceHealthIT)