Inter-organizational information sharing and bundled payment reimbursement: Do hospitals in the US use health information exchange to collaborate?

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Highlights

  • There is an association between bundled payment (BP) participation and HIE.

  • Participation in BP is associated with sending information to different types of providers.

  • However, it is not associated with receiving information through HIE from different types of providers.

  • Participation in BP is associated with more frequent use of HIE, generating higher volume of HIE.

  • Participation in BP is associated with exchanging more types of information through HIE.

Abstract

Objective

The purpose of this study is to examine the relationship between the greater need for information generated by bundled payment reimbursement and the use of Health Information Exchange (HIE).

Methods

The study is based on a secondary data analysis using theAmerican Hospital Association (AHA) Healthcare IT Database and the AHA Annual Survey. A logistic regression was used to test the likelihood of hospitals participating in HIE if they were involved in bundled payment reimbursement. Negative binomial, ordered logistic and Poisson regression models were used to determine the associations between bundled payment reimbursement and health information sharing in terms of breadth, volume, and diversity, respectively.

Results

Hospitals in bundled payment programs were more likely to send and receive information through HIE and tosend information to different types of health providers but not to receive. They were also more likely to exchange different types of health information and to use HIE more often.

Conclusions

The greater need for collaboration of hospitals participating in bundled payment programs was associated with greater information sharing among organizations through HIE, but different providers involved in the episode of care play different roles in HIE.

Introduction

Health Information Exchange (HIE) is the electronic sharing of health information among organizations according to nationally defined standards [[1], [2], [3]] and has been a relevant subject of US policymaking since the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH). HIE allows clinical information to securely follow the patient across the health and wellness continuum, enabling disparate health professionals to deliver care in an effective, efficient, and coordinated manner [4]. HIE has the potential to improve the delivery of care by reducing re-admissions, waste, duplicate testing, and medical errors [5] while potentially increasing access to care through disability determination [6]. These potential benefits of HIE are more relevant if one considers the frequency of transitions between health care settings, especially for patients with complex and chronic conditions [4]. However, the traditional fee-for-service reimbursement, which rewards the volume of care, creates no incentive for providers to reduce test duplication or to exchange information with other providers. There is hope that the introduction of bundled payments will motivate greater use of HIE [4].

Bundled payment reimbursement programs represent a paradigm shift from the traditional fee-for-service reimbursement. The US health system is in the early stages of bundled payment reimbursement, with several voluntary initiatives ongoing and the first mandatory test initiated in 2016. With a bundled payment system, providers, who are often disparate, are jointly responsible for the entire episode of care. This places providers in a reimbursement environment with increased complexity and uncertainty. Providers are no longer working in silos and should be availing themselves of information from other care providers along the health care continuum in an attempt to contain costs for each episode of care. An assumption of this paper is that this change in reimbursement scheme increases the need to share information among hospitals and other health care providers, thus potentially increasing the use of HIE.

Section snippets

Background

How organizations react to environmental uncertainty has been examined [7,8]. Research has also examined how and why organizations engage in information sharing [[9], [10], [11]]. However, little research has identified an association between environmental uncertainty and inter-organizational information sharing. One study surveyed a limited number of organizations on environmental uncertainly, information sharing, and supply chain management [12]. Another examines environmental uncertainly

Data collection

Secondary data analysis was used to explore health care IT and payment models. The American Hospital Association (AHA) Healthcare IT Database provides information on the depth and level of technology integration within hospitals. It contains information on health care IT, including HIE functionality, for more than 3300 hospitals. HIE functionality was determined with information relative to whether the organization exchanges information, how routinely it electronically exchanges clinical

Results

The sample includes 3510 hospitals. Descriptive statistics for the organizational characteristics, presented in Table 1, and for the extent of HIE participation, presented in Table 2, exhibit wide variation in most instances. A further examination of the sample was performed, focusing on how organizational characteristics differ between hospitals that participate in bundled payment programs and those that do not participate). From this further analysis, it emerges how hospitals in bundled

Discussion

Returning to the hypotheses, the results suggest:

H1

Participation in HIE: Health providers participating in bundled payment initiatives are more likely to participate in HIE initiatives than those that do not.

Health care providers participating in bundled payment initiatives seem to be more likely (6 percentage points) to engage in HIE activities than those providers that did not participate. Participation with bundled payment initiatives was also associated with the exchange of information

Conclusions

This paper analyzed how environmental uncertainty affects inter-organizational information sharing, discussing the particular case of the health care sector and, specifically, the sharing of information among hospitals in bundled payment programs. The identified conceptual framework depicted a relationship between the environmental uncertainty generated by the introduction of bundled payments reimbursement and inter-organizational information sharing measured in terms of breadth, volume, and

CRediT authorship contribution statement

Claudia Guerrazzi Young: Conceptualization, Methodology, Data curation, Formal analysis, Writing - original draft. Sue S. Feldman: Supervision, Writing - review & editing. S. Robert Hernandez: Supervision, Writing - review & editing.

Declaration of Competing Interest

The authors report no declarations of interest.

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