Objective

The objective of this study was to quantify the rate of provider participation beyond year 1 incentive in the Florida Medicaid Promoting Interoperability (PI) program, formerly the Electronic Health Record Incentive program, and identify the provider and practice characteristics associated with Meaningful Use attestations.

Methods and materials

We conducted a retrospective cohort study using the 2011–2018 records from the PI program, Provider Participation Database. Bivariate associations between Meaningful Use and categorical and ordinal variables were tested using Chi-square and Mantel-Haenszel Chi-square, respectively, with results informing logistic regressions. Adjusted odds ratios and 95 % confidence intervals are reported.

Results

We found that 42.56 % of Florida Medicaid providers achieved Meaningful Use after receiving first-year incentives. Logistic regression showed that pediatricians represented the largest percentage of providers who achieved Meaningful Use (65.06 %) while dentists had the lowest Meaningful Use (7.78 %). We also found that certain geographic areas and various EHR vendors were associated with higher rates of providers Meaningful Use attestation.

Discussion

Although the PI program successfully influenced the adoption of a basic EHR system, low Meaningful Use attestations have inadvertently created a digital “advanced use” divide among providers who serve large numbers of Medicaid patients. This is concerning because advanced EHR functions are necessary precursors to address unmet socioeconomic needs to reduce health disparities.

Conclusion

Florida has distributed over $100 million to Medicaid providers who ultimately did not achieve Meaningful Use after collecting their first-year incentive. Policy interventions that can promote advanced EHR use functions are necessary to optimize technology in low-resourced practice settings where the potential benefits are greater.

中文翻译：

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提供者参与佛罗里达医疗补助促进互操作性计划：实践特征，使用证明和奖励金

客观的

这项研究的目的是量化佛罗里达医疗补助促进互操作性（PI）计划（以前称为电子健康记录激励计划）中超过1年激励措施的提供者参与率，并确定与有意义使用证明相关的提供者和实践特征。

方法和材料

我们使用PI计划“提供商参与数据库”的2011–2018记录进行了回顾性队列研究。分别使用卡方（Chi-square）和曼特尔-汉斯泽尔（Mantel-Haenszel）卡方检验了有意义使用与分类和有序变量之间的双变量关联，结果表明了逻辑回归。报告了调整后的优势比和95％的置信区间。

结果

我们发现，佛罗里达州医疗补助提供者中有42.56％在获得第一年奖励后获得了有意义的使用。Logistic回归显示，儿科医生占获得有意义使用的提供者的比例最高（65.06％），而牙医具有最低有意义使用的提供者的比例最低（7.78％）。我们还发现，某些地理区域和各种EHR供应商与提供者有意义使用证明的比率较高相关。

讨论

尽管PI计划成功地影响了基本EHR系统的采用，但是低有意义的使用证明无意间在服务大量医疗补助患者的提供者之间造成了数字“高级使用”鸿沟。这令人担忧，因为先进的电子病历功能是解决未满足的社会经济需求以减少健康差距的必要先驱。

结论

佛罗里达州已向医疗补助提供者分配了超过1亿美元，这些医疗提供者在获得第一年的奖励后最终未能实现有意义的使用。可以促进高级EHR使用功能的政策干预措施对于优化资源匮乏，潜在收益更大的实践环境中的技术是必不可少的。