Is duration of hospital participation in meaningful use associated with value in Medicare?

Abstract

Objectives: "Meaningful Use" (MU) of electronic health records (EHRs) is a measure used by Medicare to determine whether hospitals are comprehensively using electronic tools. Whether hospitals' engagement in valuebased initiatives such as MU is associated with value defined as high quality and low costs is unknown. Our objectives were to describe hospital participation in MU, and determine whether duration of participation is associated with value. Materials and Methods: We linked national Medicare data with MU and other hospital-level and market data. We analyzed bivariate relationships to characterize duration of participation. We estimated inverse probabilityweighted multilevel logistic regressions to evaluate whether duration of participation was associated with higher likelihood of value operationalized as having performance on 30-day readmission and inpatient spending at or below the national average. Results: Of 2860 short-term hospitals, 59% had 4 or 5 years of MU participation by 2015; 7% had 1 or 2 years. There were differences by duration of participation across location, ownership, and size. Seventeen percent of hospitals were classified as high-value. Controlling for hospital characteristics, and holding constant market location, there was no evidence of a statistical association between duration of participation and value (odds ratio = 1.05, 95% confidence interval: 0.91-1.21; P=.51). Examining the 2 outcomes separately, there was a significant relationship between duration of participation and lower Medicare inpatient spending, but not 30-day readmission. Discussion: Sustained participation in MU is associated with lower Medicare spending, but not with lower readmission rates. Conclusion: Policy interventions aimed at increasing value may need a broader focus than EHR implementation and use.