Thanks in large part to reductions in ambulatory radiology spending, ambulatory electronic health records (EHRs) can slow the growth rate of outpatient care costs compared to traditional paper records, according to a pilot study published in the July 16 issue of the Annals of Internal Medicine.
In a large study from the University of Michigan that examined more than four years of healthcare cost data in nine communities in Massachusetts, growth in overall ambulatory care costs slowed by 3% in communities that implemented ambulatory EHRs.
Notably, ambulatory radiology costs decreased by 1.61% over the costs of control groups, a difference that was statistically significant. Of the estimated $5.14 in savings per member, per month (PMPM), from EHRs, $1.61 would be contributed by ambulatory radiology cost reductions, according to the researchers.
"Easier access to previous results may have prompted providers to order fewer tests, particularly in radiology," the authors wrote. "Reducing these ancillary costs may have been facilitated by the fact that most ordering providers would not incur the associated lost revenue."
Meaningful use model
Despite the U.S. government's push to drive adoption of EHRs through the meaningful use IT stimulus program, there hasn't been much evidence yet to support the theory that EHRs will yield cost savings by increasing efficiency. With the goal of assessing short-term cost savings from community-wide adoption of ambulatory EHRs, the researchers evaluated the Massachusetts eHealth Collaborative (MAeHC), a 2006 initiative that provided subsidized ambulatory EHR adoption and financial aid throughout three communities (Ann Intern Med, July 16, 2013, Vol. 159:2, pp. 97-104).
"Because participating providers reported using EHRs in similar ways to the initial meaningful use criteria (for example, entering medication orders and test result viewing), the MAeHC experiment offers timely data on how the federal meaningful use program may impact costs in the short-term," wrote the team led by Julia Adler-Milstein, PhD, an assistant professor in the University of Michigan's School of Information and School of Public Health.
The study team compared healthcare costs for patients in those three communities with costs in six control communities that had applied for but were not selected to participate in the program. In the three communities in the program, 86% of the 167 eligible practices with a relationship to their community hospital participated.
Medical and pharmacy claims data were acquired via two commercial insurers from January 2005 to June 2009 for all members who lived or received care in these communities. In a bid to maximize comparability of the patient populations, the researchers said they matched communities in the intervention and control communities, matched providers within communities, and selected patients receiving most of their care from matched providers.
The overall sample included 4,812,412 patient-month observations from 47,979 patients in the EHR intervention communities and 130,603 patients in the control communities. The patients received most of their care from 806 intervention providers or 1,597 matched control providers.
Outpatient cost savings
While no statistically significant savings from EHRs were found when examining measures of total cost or inpatient cost, savings were discovered when the researchers narrowed the scope of analysis to outpatient care and further examined outpatient costs for prescriptions, laboratory, and radiology.
Ambulatory costs increased more slowly in intervention communities than in control communities. The -0.35% absolute difference in monthly trend change was statistically significant (p = 0.012).
"Assuming $5.14 PMPM savings for the 47,979 intervention patients, it would take approximately seven years to recoup the projected five-year adoption cost in the pilot communities of $130,822 per provider," the authors wrote.
While ambulatory pharmacy, laboratory, and radiology costs (-0.35%, -0.38%, and -1.61%, respectively) all favored patients in the intervention communities, only radiology was statistically significant (p < 0.001).
"It was the only outcome with an absolute decrease in monthly cost growth in the pre- to postimplementation periods for intervention patients (from 1.03% to 0.60%), whereas the cost trajectory increased among control patients," the authors wrote.
Providers in the pilot program reported that viewing laboratory and radiology test results were among the most common uses of their EHRs.
The projected $1.61 PMPM ambulatory radiology savings represented 1.07% of total PMPM cost, according to the researchers.
Substantial savings
If sustained over several years, reducing health spending from ambulatory EHRs by the magnitude observed in the study would result in substantial savings, the group concluded.
"Larger savings are possible if providers have incentives to deliver more efficient care," they wrote. "Efforts to reform financing and delivery of care alongside greater use of EHRs may focus clinicians' attention on how best to leverage their EHR to achieve savings and help realize the full benefit from our large national investment in EHRs."
