No dollar amount of cost savings was calculated for the reduced visits, but that doesn't mean those savings were negligible, nor limited to the three image types under the study, according to the study authors.
“Although our projected avoided costs are small relative to the annual healthcare expenditures in the United States, we intentionally examined a narrow clinical scenario in which HIE is likely to have an impact and estimated conservative cost savings,” authors said. “Nevertheless, these findings bolster the rationale behind federal policy efforts to achieve nationwide HIE.”
The federal government appropriated $548 million under the American Recovery and Reinvestment Act of 2009 to promote the development of state and regional HIEs.
The authors also pointed to “the ongoing challenges of misaligned” financial incentives in which payers are the beneficiaries of reductions in billable activities, such as fewer imaging tests ordered, but “payers have been reluctant to support HIE, in large part because they are not convinced that they will in fact realize benefits.”
The authors suggest their findings “should help reassure payers that they may realize savings” from HIEs as well as motivate greater provider investment in HIEs, “particularly as the country moves toward global payments for episodes of care, which will invoke strong incentives for reducing redundant imaging.”
“I think if we can get the financial incentives a little more closely aligned with the potential of this technology, then perhaps some of the modest effects we see in our study will be modified” and increased, said Eric Lammers, who performed data analysis for the study as part of doctoral work at the University of Michigan's School of Public Health, and who is now a health researcher at Mathematica Policy Research.
Lammers said that while their research was limited to California and Florida, both are geographically large, diverse and populous states at either ends of the nation, and their findings are “certainly representative within those two states.” His hope, he said, is that their work “opens the door and points the way to research in other settings that will say how generalizable this is in other settings.”
Data for the study came from state-level emergency department databases from 2007-2010. The researchers used the HIMSS Analytics database to determine HIE participation by hospitals in the study and referred to the American Hospital Association's annual hospital survey for hospital characteristics.
Follow Joseph Conn on Twitter: @MHJConn