Abstract
The Electronic Health Records (EHR) Demonstration, implemented by the Centers for Medicare & Medicaid Services (CMS), provided financial incentives to physician practices to use a certified EHR. Practices that met minimum EHR use requirements received payments on a graduated scale, increasing for more use of EHR functions.
The demonstration was implemented in four sites, targeting practices with 20 or fewer providers supplying primary care to at least 50 fee-for-service Medicare beneficiaries. The demonstration was expected to operate for five years (June 1, 2009–May 31, 2014), but was cancelled in August 2011 because 43% of the practices did not meet program requirements. The evaluation used a stratified, experimental design—412 treatment and 413 control practices—to estimate the impacts of the payments on adoption and use of EHR functionalities.
In June 2011, treatment group practices were, on average, 9 to 18 percentage points more likely than control group practices to report using 13 EHR functionalities queried at baseline (2008). The payments increased a summary score of EHR use, which ranged from 1 to 100, by more than 11 points on average relative to the control group (54 versus 43).
Moderate incentive payments did not lead to universal EHR adoption and use in a two-year time frame. However, the demonstration showed that incentives can influence physician use of EHRs. These results are encouraging regarding the potential effectiveness of the EHR Medicare Incentive Program but also suggest that meaningful use of EHRs on a national scale may take longer than anticipated.