Journal of Healthcare Management - July/August 2014 - (Page 281)

H o s pI ta l c Haracter I st I cs a ssoc I ate D w It H a cHIeve Ment .01), those with a single EHR vendor (OR = 1.43; marginal effect = 7.3; p < .01), and those eligible for Medicaid incentives (OR = 1.25; marginal effect = 4.5, p < .01) were more likely than their counterparts to receive Medicare MU incentive payments. On the other hand, hospitals that were part of a system (OR = 0.73; marginal effect = −6.5; p < .01) and those located in the Mountain (OR = 0.38; marginal effect = −18.2; p < .01) and Pacific (OR = 0.22; marginal effect = −25.3; p < .01) regions were significantly less likely to have received Medicare MU incentive payments relative to hospitals in the New England region. Hospitals in the Middle Atlantic (OR = 1.81; marginal effect = 13.5; p < .01) and South Atlantic (OR = 1.48; marginal effect = 8.8; p < 0.05) regions were significantly more likely to have received Medicare MU incentive payments relative to hospitals in the New England region. DISCUSSION The main finding from our analysis is that adoption of an EHR system prior to the start of the incentive program was the strongest predictor of achieving MU among the approximately 38% of eligible hospitals that had achieved MU as of December 2012. Thus, the EHR incentive program seems to have disproportionately rewarded hospitals that had already been engaging in the desired behavior. At this early stage of the MU program, this finding raises the concern that the EHR incentive program may not rapidly achieve the intended goal of widespread EHR MU, which, because of low national EHR adoption rates, must be driven by new EHR of M eanIngful u se implementations (Jha et al., 2009; Blumenthal, 2010). Additionally, although more than two thirds of hospitals with a comprehensive EHR in 2010 earned an MU payment through 2012 and the definition of comprehensive EHR was aligned to the EHR MU criteria, 30% of organizations with the IT infrastructure in place to meet the MU criteria failed to attest to their eligibility for Medicare incentive payments. Although our analysis cannot determine why the facilities with advanced EHR systems did not participate in the MU program, previous research has found that hospitals that failed to achieve MU in 2011 were more likely to report challenges with meeting the computerized provider order entry (CPOE) MU objective (Harle, Huerta, Ford, Diana, & Menachemi, 2012). These issues may stem from the social, organizational, and technological challenges of implementing CPOE that can lead to implementation failures and lack of consistent use by physicians. Further, assuming that hospital management performs marginal analyses before adopting new technology, we would expect the MU incentives to increase marginal revenue for those hospitals closest to achieving comprehensive EHR status and MU. It may be that additional time is needed before EHR adoption can be accelerated in response to the HITECH Act incentives. On the other hand, the goals of reducing Medicare costs by providing greater incentives to high-volume Medicare hospitals may be having the desired impact. We found evidence that, after controlling for other factors, an increase in Medicare share was 281

Table of Contents for the Digital Edition of Journal of Healthcare Management - July/August 2014

Journal of Healthcare Management - July/August 2014
Contents
Interview With Charles R. Evans, FACHE, President of the International Health Services Group and Senior Advisor at Jackson Healthcare
The Most Effective Leadership Style for the New Landscape of Healthcare
Exploring Obstacles to Success for Early Careerists in Healthcare Leadership
Decisions Through Data: Analytics in Healthcare
Sustainable Competitive Advantage for Accountable Care Organizations
Hospital Characteristics Associated With Achievement of Meaningful Use
The Effect of Professional Culture on Intrinsic Motivation Among Physicians in an Academic Medical Center
Abstract from the Academy of Management

Journal of Healthcare Management - July/August 2014