The impact of electronic health records on ambulatory costs among Medicaid beneficiaries

'A review of the article by Adler-Milstein et al., The Impact of Electronic Health Records on Ambulatory Costs Among Medicaid Beneficiaries'

Introduction

Despite the lack of empirical data regarding the effectiveness and cost savings of health information technology (HIT) and electronic health records (EHRs), the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act provided $30 billion in incentives to providers to become meaningful users of EHRs hoping that EHRs will improve healthcare quality and reduce healthcare costs. This study examined how one of the first deployments of a community-wide ambulatory EHR impacted healthcare costs of Medicaid recipients.

Methods

The study included data from Medicaid recipients receiving care from three Massachusetts eHealth Collaborative (MAeHC) pilot communities or in six matched control communities. A difference-in-differences slope analysis was used to compare and assess costs with recipient visits.

Results

The study found that EHR adoption impacted ambulatory medical cost in two of the three MAeHC pilot communities or in six matched control communities. In all of the communities, ambulatory medical costs increased more slowly in the post-period compared to the pre-period, which the authors believe was driven in part by changes in visit rates.

Discussion

This was the first study of its kind to examine the empirical data specifically associated with Medicaid recipients and the adoption of EHRs among primary care physicians. The study found evidence that EHRs do impact ambulatory medical costs partly as a result of visits, however, the study was not able to find this impact across all of the pilot communities meaning that EHRs can increase or decrease costs and that is dependent upon what context they adopted and used.

Conclusion

In conclusion, adoption and implementation of a commercially available EHR system in 2013 did not have a consistently large impact oo Medicaid recipients’ healthcare costs and the study was not able to determine whether there were significant cost-savings. The authors suggested additional Meaningful Use criteria and additional incentives to reduce healthcare costs would be essential to EHR adoption.

Comments

This is an article from 2013 and many studies have looked at the cost savings of EHR implementation since that time. However, it was still interesting to see that the study was unable to determine actual cost savings (specifically among Massachusetts communities that serve Medicaid recipients) with EHR adoption and implementation. It is also interesting to see that even two years later, we are still able to find studies that argue EHRs promote cost-savings and other studies that discuss the increased costs of implementation. Finally, the opening sentence of this article discusses how the government passed a bill with $30 Billion dollars in incentives for providers to become meaningful users of EHRs with a projected cost savings of $3 to $80 Billion in healthcare costs without strong evidence showing the implementation and adoption EHRs could actually produce the projected cost-savings.