Center for Studying Health System Change

	Joy M. Grossman
	Marie C. Reed

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Most Medicare Outpatient Visits are to Physicians with Limited Clinical Information Technology

Data Bulletin No. 30
July 2005
Joy M. Grossman, Marie C. Reed

doption of clinical information technology (IT) in physicians’ practices has the potential to improve quality and reduce the cost of care for people with complex health problems, including many Medicare patients. Monitoring adoption trends and assessing gaps in Medicare patients’ access to physicians with clinical IT are important as policy makers try to speed IT adoption. A majority of Medicare fee-for-service outpatient visits in 2001 were to physicians without significant IT support for patient care, according to a new baseline analysis of Medicare claims data linked to the Community Tracking Study (CTS) Physician Survey. At the same time, more vulnerable beneficiaries, including those who were sicker, living in low-income or rural areas, or who were black, did not have significant differences in access to physicians with clinical IT.

More than half of Medicare outpatient visits (57%) were to physicians in practices that used IT for no more than one of the following five clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating preventive treatment reminders for the physician’s use, and writing prescriptions. Access rates across individual clinical functions varied considerably. While half of Medicare outpatient visits were to practices using IT to obtain treatment guidelines, the proportion of visits to practices with IT support for other patient care functions was much lower, falling to 9 percent of visits to practices with electronic prescribing (see Table 1). Medicare beneficiaries’ limited access to physicians with clinical IT mirrors the general population, since it reflects physicians’ slow rate of IT adoption.1

No Disadvantage for More Vulnerable Beneficiaries

he sickest Medicare patients are likely to benefit the most from seeing physicians using clinical IT because of the complexity of their cases and the need for care coordination. While access to physicians using IT was low for all beneficiaries, there were few differences in access between sicker and healthier beneficiaries. For example, across the five clinical functions, there were only small differences in the percentage of outpatient visits to physicians using IT between the sickest third of Medicare patients—as measured by a comorbidity index2—and the healthiest third. Similar results were found for outpatient visits by the frail elderly—those 85 and older—and by beneficiaries eligible for Medicare because of disability. However, there were substantial differences for patients with end-stage renal disease that vary by clinical IT function (see Supplementary Table 1).

Some policy makers are concerned that patients in rural areas or underserved low-income urban areas are less likely to have access to physicians with clinical IT because these providers may be slower to adopt IT. However, outpatient visits by Medicare patients living in rural or lowincome areas were as likely as or, in a few instances, more likely than those in urban or more affluent areas to be with physicians in practices using IT (see Table 2). And, visits by black patients were as likely to be to physicians in practices with IT as visits by white patients.

Policy Implications

hile patient characteristics are only loosely associated with the likelihood that Medicare outpatient visits will be to physicians in practices using clinical IT, multivariate analysis suggests that physician characteristics are far more important. In particular, practice setting—especially practice size—and, to a lesser extent, physician specialty played far more important roles in predicting whether outpatient visits were to physicians with clinical IT (see Supplementary Table 2). More than three-fourths of Medicare outpatient visits were to physicians in practices with fewer than 50 physicians, the practices that are least likely to adopt clinical IT. Currently, Medicare is targeting some efforts to speed IT adoption at smaller practices, including technical assistance and a chronic-care payfor- performance demonstration. Broader policy efforts—including financial incentives—may be needed, however, to substantially improve patient access. Policy makers also will need to monitor trends to assure that patients who can benefit most from clinical IT have access to physicians using these tools.

Notes

Supplemental Tables

Supplemental Table 1 - Medicare Outpatient Visits to Physicians in Practices with IT Support for Specific Patient Care Functions in 2001, by Patient Age and Medicare Eligibility

Supplemental Table 2 - Adjusted Odds Ratios for Likelihood of Medicare Outpatient Visits to Physicians in Practices with IT to Support Specific Patient Care Functions in 2001