Abstract
Interoperable patient data exchange across hospitals remains an important policy goal for reducing costs and improving the quality of care. Congress designated 2018 as the goal for nationwide interoperability, and policy makers hoped that aligning financial incentives via alternative payment models (APMs) would help achieve that goal. To measure interoperability progress since 2014, assess the association between alternative payment model participation and hospital engagement in interoperable data sharing from 2014 to 2018, and evaluate hospital-reported barriers to interoperability in 2018. This cohort study included nonfederal acute care hospitals in the US from January 2014 to December 2018 that responded to the American Hospital Association Annual Survey. Data were analyzed from October 2019 through March 2021. Participation in an APM, including accountable care organizations, bundled payments, or patient-centered medical homes. Hospital engagement in all 4 domains of interoperability: finding/querying for data, sending data electronically, receiving data electronically, and integrating electronic patient data from external care delivery organizations. The sample included 3928 hospitals in the US from January 2014 to December 2018. Progress across interoperability domains was uneven, 2430 (88.3%) hospitals sending and 2115 (76.9%) receiving patient data electronically in 2018. However, only 1249 (45.4%) hospitals engaged in all 4 domains of interoperability in 2018, and growth between 2014 and 2018 was slow. There was no evidence that participation in APMs was associated with interoperability, with multivariate models suggesting that participation in an APM was associated with only a non-statistically significant 1-percentage point increase in interoperability engagement (β = 0.01; 95% CI, -0.01 to 0.03). The most commonly cited barrier to interoperability was challenges associated with sharing data across different electronic health record vendors. In this cohort study of hospital interoperability, fewer than half of US hospitals were engaged in interoperable data exchange in 2018. There was no observable evidence that hospital APM participation was associated with interoperability engagement. Many hospitals report technical and governance challenges to data sharing that are unlikely to be addressed by the alignment of financial incentives alone.
Highlights
There was no evidence that participation in alternative payment model (APM) was associated with interoperability, with multivariate models suggesting that participation in an APM was associated with only a non–statistically significant 1–percentage point increase in interoperability engagement (β = 0.01; 95% CI, −0.01 to 0.03)
There was no observable evidence that hospital APM participation was associated with interoperability engagement
In multivariate models with hospital and year fixed effects, we found no evidence that participation in an APM was associated with interoperability engagement, regardless of the independent variable as participation in any APM (β = 0.01; 95% CI, −0.01 to 0.03) or separately for patient-centered medical homes (PCMH) (β = 0.01; 95% CI, −0.02 to 0.03), bundled payments (β = −0.01; 95% C, −0.04 to 0.02), and accountable care organizations (ACOs) (β = 0.01; 95% CI, −0.01 to 0.04) (Table 1)
Summary
One policy mechanism by which Congress intended to achieve the goal of national interoperability by 2018 was via programs designed to better align financial incentives to encourage data sharing known as alternative payment models (APMs), as described in the US Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA) of 2015. While other efforts to encourage interoperability were underway during this period, policy makers and researchers focused on these payment reform initiatives as some of the most promising potential drivers of interoperability.[11] In contrast, health information technology (IT) provisions of the 21st Century Cures Act took a targeted approach by directly advancing technology, standards, and governance models with the aim of reducing the technical and administrative complexity of interoperability and addressing specific barriers, such as information blocking
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