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Meaningful Use of Electronic Health Records by Outpatient Physicians and Readmissions of Medicare Fee-for-Service Beneficiaries

Unruh, Mark A., PhD; Jung, Hye-Young, PhD; Vest, Joshua R., PhD; Casalino, Lawrence P., MD, PhD; Kaushal, Rainu, MD, MPH for the HITEC Investigators

doi: 10.1097/MLR.0000000000000695
Original Articles

Background: Nearly one-fifth of hospitalized Medicare fee-for-service beneficiaries are readmitted within 30 days. Participation in the Meaningful Use initiative among outpatient physicians may reduce readmissions.

Objective: To evaluate the impact of outpatient physicians’ participation in Meaningful Use on readmissions.

Subjects and Research Design: The study population included 90,774 Medicare fee-for-service beneficiaries from New York State (2010–2012). We compared changes in the adjusted odds of readmission for patients of physicians who participated in Meaningful Use—stage 1, before and after attestation as meaningful users, with concurrent patients of matched control physicians who used paper records or electronic health records without Meaningful Use participation. Three secondary analyses were conducted: (1) limited to patients with 3+ Elixhauser comorbidities; (2) limited to patients with conditions used by Medicare to penalize hospitals with high readmission rates (acute myocardial infarction, congestive heart failure, and pneumonia); and (3) using only patients of physicians with electronic health records who were not meaningful users as the controls.

Main Outcome: Thirty-day readmission.

Results: Patients of Meaningful Use physicians had 6% lower odds of readmission compared with patients of physicians who were not meaningful users, but the estimate was not statistically significant (odds ratio: 0.94, 95% confidence interval, 0.88–1.01). Estimated odds ratios from secondary analyses were broadly consistent with our primary analysis.

Conclusions: Physician participation in Meaningful Use was not associated with reduced readmissions. Additional studies are warranted to see if readmissions decline in future stages of Meaningful Use where more emphasis is placed on health information exchange and outcomes.

*Department of Healthcare Policy & Research

Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, NY

Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN

§Department of Pediatrics, Weill Cornell Medical College

New York-Presbyterian Hospital

Department of Medicine, Weill Cornell Medical College, New York, NY

The New York State Department of Health’s Healthcare Efficiency and Affordability Law for New Yorkers Program (HEAL NY)—Phase 17 Evaluation (Contract #C026734)—provided funding support for this project. M.A.U. reports personal fees from NaviHealth. The remaining authors declare no conflict of interest.

Reprints: Mark A. Unruh, PhD, Department of Healthcare Policy and Research, Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065. E-mail:

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