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Meaningful Use and Hospital Performance on PostAcute Utilization Indicators

Objectives: To examine trends in hospital postacute utilization indicators and to determine whether improvement in these indicators is associated with attesting to meaningful use (MU).

Data Sources: Medicare claimsbased, repeated measures on 30day hospitalwide allcause readmission and emergency department (ED) utilization rates for 160 shortstay hospitals (2009–2012); Medicare EHR Incentive Program Payments files (2011–2012); and other hospital and market data.

Study Design:Interrupted time series with concurrent comparison group.

Principal Findings:Propensity scoreweighted multilevel models for change demonstrate that 30day readmission rates (unadjusted) fell from 13.4 percent in 2009 to 12.1 percent in 2012. Similarly, 30day ED utilization declined from 18.9 percent to 17.3 percent during the same period. However, MU and nonMU hospitals were indistinguishable visàvis performance. Controlling for hospital and market characteristics, MU was unrelated to 30day readmission. In contrast, 30day ED utilization deteriorated.

Conclusions:Hospitals with MU Stage 1 designation did not show significantly higher improvement on postacute utilization compared to their counterparts without. To achieve gains in quality and safety, potentially associated with EHRs, and to advance care coordination and patient engagement, the regulators should strengthen accountability by linking comprehensive, outcomesbased performance measures to specific MU objectives.

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