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Incentives for ACOs Outweigh Meaningful Use

Policymakers should align Meaningful Use incentives with alternative payment models. (Volume 9, Issue 31)

Of the initiatives the federal government has launched in an effort to advance quality, encourage efficiency, and reduce the cost of health care, the (ACO) model continues to succeed. The Centers for Medicare and Medicaid Services’ authorization to disburse incentive payments to ACOs now rewards participating providers that surpass quality benchmarks and curtail costs.

Source: NEC Corporation of America (Flickr/CC)

Concurrently, the and providers to adopt health information technology (IT), while penalizing non-adoption and non-use. Although ACO incentives are not directly tied to health IT adoption, providers participating in ACOs must possess robust health IT structures that support care coordination mechanisms necessary to achieve cost and quality goals.

A recent article provides evidence that hospitals participating in ACOs have greater adoption of health IT than non-ACO hospitals, particularly in the Meaningful Use Stage 2 measures of patient-facing technology (39.8% vs. 15.2%; p<0.001) and (49.0% vs 30.1%; p<0.001). Interestingly, multivariate analyses to determine the adjusted effect of ACO participation on health IT adoption revealed no difference between ACO and non-ACO hospital ability to meet Meaningful Use Stage 2. This dichotomy suggests ACO hospitals may look beyond incentives for health IT adoption and pursue a strategy of aligning health IT investments with ACO goals.

One of the principle goals set by the National Quality Strategy to guide all healthcare quality initiatives is patient and family engagement. Leadership at ACO hospitals may see investment in tools that facilitate better communication with patients as a key tactic to enhance quality, increase patient retention, reduce costs, and improve outcomes. Although investing in patient-facing health IT may be a logical investment for ACO hospitals, non-ACO hospitals may only have the bandwidth to focus on incentives for Meaningful Use adoption.

Current evidence suggests that ACO incentives may be a better driver of change than Meaningful Use incentives. As a result, alignment of Meaningful Use goals with the goals of ACOs may be a productive path forward for policymakers.

This Policy Prescriptions® review is written by Jennifer N. Kistama, BSN, RN. She is a Neonatal Intensive Care nurse with a passion for providing patient-centered and efficient care. She is currently a dual Healthcare Administration and Health Law Master’s candidate at the University of Pennsylvania.


OBJECTIVES: The aim of this study was to evaluate health information technology (IT) adoption in hospitals participating in accountable care organizations (ACOs) and compare this adoption to non-ACO hospitals. 

STUDY DESIGN: A cross-sectional sample of US nonfederal, acute care hospitals with data from 3 matched sources:  the 2013 American Hospital Association (AHA) Annual Survey, the 2013 AHA Survey of Care Systems and Payments (CSP), and the 2014 AHA Information Technology Supplement. 

METHODS: To compare health IT adoption in ACO- and non-ACO hospitals, we created measures of Meaningful Use (MU) Stage 1 and Stage 2 core and menu criteria, patient engagement–oriented health IT, and health information exchange (HIE) participation. Adoption was compared using both naïve and multivariate logit models. 

RESULTS: Of the 393 ACO hospitals and 810 non-ACO hospitals, a greater percentage of ACO hospitals were capable of meeting MU Stage 1 (50.9% vs 41.6%; P <.01) and Stage 2 (7.6% vs 4.8%; P <.05), having patient engagement health IT (39.8% vs 15.2%; P <.001), and participating in HIE (49.0% vs 30.1%; P <.001). In adjusted models, no difference was found between ACO and non-ACO hospital ability to meet MU Stage 1 or Stage 2, but ACO hospitals were more likely to have patient engagement health IT (odds ratio (OR), 2.20; 95% CI, 1.59-3.04) and be HIE participants (OR, 1.41; 95% CI, 1.03-1.92). 

CONCLUSIONS: ACO-participating hospitals appear to be focused more on adopting health IT that aligns with broader strategic goals rather than those that achieve MU. Aligning adoption with quality and payment reform may be a productive path forward to encourage hospital health IT adoption behavior.

PMID: 27982667 Walker, DM, et al. Am J Manag Care. 2016; 22 (12): 802-807.