Participating in APMs Linked with Low HIE Volume

The value of HIE volume was just 48 percent in hospitals participating in full-year APMs.

Hospitals that participated in full-year alternative payment models (APMs) were associated with lower health information exchange (HIE) volume, according to a study published in the American Journal of Managed Care.

Key findings of the study also showed that full-year APM participation was linked to greater HIE diversity, breadth and depth.

Sunny C. Lin, M.S., School of Public Health at the University of Michigan, and her team set out to assess whether hospital participation in APMs was linked with greater engagement in HIE along four dimensions: volume of patients that information was exchanged for, diversity of information types, breadth of partner types and depth of technical approach.

>> READ: Electronic Health Information Exchange Use in Skilled Nursing Facilities

Volume was measured as the proportion of discharged patients whose summary of care records were sent electronically during a hospital’s stage two Meaningful Use attestation period.

Breadth was measured as the number of partner behavior types a hospital routinely sent structured summary of care records.

The team assessed whether or not a hospital routinely transmitted summary of card records using push or pull, or both approaches to measure depth.

Diversity was measured as the number of data types routinely sent electronically by a hospital to providers outside its system.

“Our finding that APM participation was associated with greater HIE diversity, breadth and depth suggests that value-based payment may be spurring improvements in HIE infrastructure,” the authors wrote.

The low HIE volume finding suggests that there might be an incentive to focus HIE investments on a limited number of partners.

Researchers pooled data about APM participation from Leavitt Partners data, Medicare public use files and a survey from the American Hospital Association (AHA). The Medicare data measured the HIE volume for 798 hospitals and the AHA survey measured diversity, breadth and depth for 1,730 hospitals.

The unadjusted results of the analysis revealed that the average value of HIE volume was 53 percent among hospitals that did not participate in APMs for a full year, compared to 48 percent among hospitals that did participate.

The average value of HIE diversity was 2.4 data types for nonparticipants, compared to 3.1 for participants. The value of HIE breadth was 1.2 partner types for nonparticipants and 1.8 for participants. The percentage of hospitals that used both push and pull approaches was 54 percent among nonparticipants and 69 percent among participating hospitals.

According to the authors, HIE volume requires workflow changes that depend on clinician involvement.

“It may be that hospitals that participate in APMs increase the burden on clinicians to engage in multiple quality improvement initiatives at once, resulting in change fatigue and poorer performance on HIE value,” the authors wrote.

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