Challenges Facing Pediatricians Participating in Electronic Health Records Incentive Programs

Although the intent of the federal Meaningful Use (MU) program is to improve the health of children and adults through adoption and use of electronic health records (EHRs), the program’s current structure disadvantages pediatricians compared to adult providers, leading to wide variability in pediatrician participation across states, from less than 10% in New Jersey, Georgia and Hawaii to nearly 70% in North Dakota.

Pediatricians seeking MU payments for using EHRs must exceed a 20% patient threshold of Medicaid-insured children, whereas adult providers can participate through the Medicare EHR incentive program, which has no patient threshold.

Qualifying for the MU program through Medicaid is more difficult than through Medicare because 1) Medicaid participation is based in part on each state’s reimbursement rates and policies; 2) children enrolled in a state’s separate Children’s Health Insurance Program (CHIP) are excluded from the patient threshold calculation; and 3) a lack of centralized reporting for pediatricians interested in receiving incentives creates a cumbersome process compared to Medicare’s single central federal repository.

Pediatrician participation in the MU program can be increased through several policy solutions including: 1) universally allowing providers to include CHIP patients in their patient threshold; 2) no longer requiring a patient threshold for pediatricians’ MU participation; and 3) collaborating with private payers and health systems to offer tax credits or payment incentives to pediatricians who do not meet the patient threshold.