This is the accessible text file for GAO report number GAO-14-21R 
entitled 'Electronic Health Records: Number and Characteristics of 
Providers Awarded Medicare Incentive Payments for 2011-2012' which was 
released on October 24, 2013. 

This text file was formatted by the U.S. Government Accountability 
Office (GAO) to be accessible to users with visual impairments, as 
part of a longer term project to improve GAO products' accessibility. 
Every attempt has been made to maintain the structural and data 
integrity of the original printed product. Accessibility features, 
such as text descriptions of tables, consecutively numbered footnotes 
placed at the end of the file, and the text of agency comment letters, 
are provided but may not exactly duplicate the presentation or format 
of the printed version. The portable document format (PDF) file is an 
exact electronic replica of the printed version. We welcome your 
feedback. Please E-mail your comments regarding the contents or 
accessibility features of this document to Webmaster@gao.gov. 

This is a work of the U.S. government and is not subject to copyright 
protection in the United States. It may be reproduced and distributed 
in its entirety without further permission from GAO. Because this work 
may contain copyrighted images or other material, permission from the 
copyright holder may be necessary if you wish to reproduce this 
material separately. 

GAO-14-21R: 

GAO: 
United States Government Accountability Office: 
441 G St. N.W. 
Washington, DC 20548: 

October 24, 2013: 

Congressional Committees: 

Electronic Health Records: Number and Characteristics of Providers 
Awarded Medicare Incentive Payments for 2011-2012: 

Widespread use of health information technology, such as electronic 
health records (EHR), has the potential to improve the quality of care 
patients receive and reduce health care costs. However, studies have 
estimated that as of 2009, 78 percent of office-based physicians and 
91 percent of hospitals had not adopted EHRs.[Footnote 1] The Health 
Information Technology for Economic and Clinical Health (HITECH) Act, 
enacted as part of the American Recovery and Reinvestment Act of 2009 
(Recovery Act), among other things, provided funding for various 
activities intended to promote the adoption and meaningful use of 
certified EHR technology.[Footnote 2] The largest of these activities, 
in terms of potential federal expenditures, are the Medicare and 
Medicaid EHR programs.[Footnote 3] Starting in 2011, these programs 
have provided incentive payments for certain providers, including both 
hospitals and health care professionals such as physicians and 
dentists, that demonstrate meaningful use of certified EHR technology 
and meet other program requirements established by the Centers for 
Medicare & Medicaid Services (CMS). Beginning in 2015, the Medicare 
EHR program is generally required to begin applying a payment 
adjustment--that is, a payment reduction--for Medicare providers that 
do not demonstrate meaningful use. The Congressional Budget Office 
estimated total spending for the Medicare and Medicaid EHR programs to 
be $30 billion from 2011 through 2019, of which spending for the 
Medicare EHR program accounts for more than half--$17.7 billion. This 
report focuses on the Medicare EHR program.[Footnote 4] 

Provisions in the HITECH Act defined the types of hospitals and 
professionals that may be eligible to receive Medicare EHR incentive 
payments. Eligible hospitals include acute care hospitals and critical 
access hospitals.[Footnote 5] Eligible professionals include doctors 
of medicine, dental medicine or surgery, optometry, osteopathy, and 
podiatric medicine and chiropractors.[Footnote 6] Hospitals can 
receive Medicare EHR incentive payments for up to 4 years, and 
professionals can receive such payments for up to 5 years.[Footnote 7] 
To receive incentive payments from the Medicare EHR program, hospitals 
and professionals must demonstrate meaningful use of certified EHR 
technology.[Footnote 8] The incentive payment amounts are determined 
as follows: 

* For acute care hospitals, the Medicare EHR incentive payment amount 
for any given year is generally based on the hospital's annual 
discharges and Medicare share, which is the percentage of the 
hospital's inpatient bed days that were attributable to Medicare 
patients. Theoretically, $6,370,400 is the maximum possible Medicare 
EHR incentive payment for an acute care hospital for 2012.[Footnote 9] 

* For critical access hospitals, the Medicare EHR incentive payment 
amount is generally based on the hospital's Medicare share as well as 
reasonable costs incurred for the purchase of depreciable assets 
necessary to administer certified EHR technology, such as computers 
and associated hardware and software. CMS has not established a 
maximum incentive payment amount for these hospitals. 

* For professionals, the amount of Medicare EHR incentive payment in 
any given year is generally based on the professional's Medicare Part 
B charges.[Footnote 10] For most professionals first participating for 
2012, the amount of the incentive payment for 2012 could not exceed 
$18,000. For most professionals first participating in 2011, the 
amount of the incentive payment for 2012 could not exceed $12,000. For 
professionals who predominately furnished services in geographic areas 
designated as a health professional shortage area, the maximum 
incentive payment amount was increased by 10 percent, to either 
$19,800 or $13,200. 

The HITECH Act requires us to report on, among other things, its 
effect on the adoption of EHRs by providers.[Footnote 11] In response 
to this requirement, in April 2012 we reported on CMS's efforts to 
oversee the Medicare EHR program during its first year as well as 
challenges encountered by providers and strategies they used to 
participate in the program.[Footnote 12] We recommended that CMS take 
steps to enhance its processes to verify that providers met the 
requirements to receive incentive payments. On behalf of CMS, the 
Department of Health and Human Services agreed with most of our 
recommendations. In July 2012 we reported information on providers 
that were awarded Medicare EHR incentive payments for 2011, including 
the number of award recipients and their characteristics.[Footnote 13] 
In December 2012 we reported information on providers that were 
awarded Medicaid EHR incentive payments for 2011, including the number 
of award recipients and their characteristics.[Footnote 14] 

Concerns have been raised that various factors, such as location in 
urban or rural areas or the size of hospitals and professional 
practices, may affect the extent to which different providers will 
demonstrate the meaningful use of EHR technology in response to the 
provisions of the HITECH Act. Identifying the number and 
characteristics of providers that participated during the first and 
second years of the Medicare EHR program can provide important 
information on whether certain types of providers were more likely 
than others to participate. This information could also provide an 
early indication of the types of providers that may be more likely to 
receive payment reductions in future years of the program. As 
discussed with the committees of jurisdiction, in this report we 
provide this information on providers that were awarded Medicare EHR 
incentive payments for 2011 and 2012, the first and second years of 
the program. 

To provide information on providers--that is, hospitals and 
professionals--awarded Medicare EHR incentive payments for 2011 and 
2012, we analyzed data related to the 2011 and 2012 program years that 
CMS collected from January 3, 2011, through July 2, 2013, as well as 
data from CMS and other government sources on provider 
characteristics. We used these data to: 

* determine the number of providers that were awarded a Medicare EHR 
incentive payment for 2012 and compare that information to the number 
of providers awarded a Medicare EHR payment for 2011; 

* estimate the percentage of eligible providers that were awarded a 
Medicare EHR incentive payment for 2012 and compare that information 
to the percentage of providers awarded a Medicare EHR payment for 2011; 

* determine the amount of Medicare EHR incentive payments awarded to 
providers for 2012 and compare that information to the amount of 
Medicare EHR payments awarded for 2011; and: 

* examine the characteristics of providers that were awarded Medicare 
EHR incentive payments for 2012 and compare that information to the 
characteristics of providers awarded Medicare EHR payments for 2011. 

To determine the number of providers that were awarded a Medicare EHR 
incentive payment in each year, we counted the number of providers 
that had an incentive payment disbursed to them. To estimate the 
percentage of eligible providers awarded a Medicare EHR incentive 
payment in each year, we divided the number of providers awarded an 
incentive payment in the year by the total number of eligible 
providers in the same year. To determine the total amount of Medicare 
EHR incentive payments awarded to providers in each year, we summed 
the Medicare EHR incentive payments awarded to providers in each year. 
We also examined the distribution of the Medicare incentive payments 
across providers in each year. Specifically, for hospitals, we 
determined the minimum, maximum, and median Medicare EHR incentive 
payment amount in each year. For professionals, we determined the 
percentage in each year who were awarded an incentive payment of any 
amount. 

To examine the characteristics of providers awarded Medicare EHR 
incentive payments for 2011 and 2012, we analyzed data from CMS, the 
Health Resources and Services Administration, and the Office of the 
National Coordinator for Health Information Technology (ONC). As part 
of our analysis, we compared the characteristics of providers that 
were awarded Medicare EHR incentive payments for 2012 to (a) those of 
providers that were eligible for the Medicare EHR program but were not 
awarded a payment for 2012 and (b) those of providers that were 
awarded Medicare EHR payments for 2011. For hospitals, these 
characteristics included, for example, whether the hospital was 
classified as an acute care hospital or critical access hospital and 
whether the hospital was a member of a chain. For professionals, these 
characteristics included whether the professional had signed an 
agreement to receive technical assistance from a Regional Extension 
Center.[Footnote 15] To ensure the reliability of the various data we 
analyzed, we interviewed officials from CMS and ONC; reviewed relevant 
documentation; and conducted electronic testing to identify missing 
data and obvious errors. On the basis of these activities, we 
determined that the data we analyzed were sufficiently reliable for 
our analysis.[Footnote 16] Enclosure I provides additional information 
on our scope and methodology. 

We conducted this performance audit from April 2013 to October 2013 in 
accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe 
that the evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives. 

In summary, hospitals and professionals were awarded a total of $6.3 
billion in Medicare EHR incentive payments for 2012, which is more 
than twice the $2.3 billion awarded to hospitals and professionals for 
2011. For 2011 and 2012, the first 2 years of the Medicare EHR 
program, hospitals and professionals were awarded a total of $8.6 
billion in Medicare EHR incentive payments. Almost half of eligible 
hospitals and less than a third of eligible professionals received 
Medicare EHR incentive payments for 2012. 

Hospital incentive payments. For 2012, 2,291 hospitals were awarded a 
total of $3.5 billion in Medicare EHR incentive payments.[Footnote 17] 
These 2,291 hospitals represent 48 percent of the eligible hospitals 
and an increase compared to 2011, when 777 hospitals, or 16 percent of 
those eligible, were awarded payments. (See table 1.) In 33 states, 
less than half of eligible hospitals received incentive payments for 
2012; in 18 states, the percentage that received incentive payments 
was 50 percent or more. 

Table 1: Participation in the Medicare EHR Program by Hospitals: 

Number (percentage of eligible); 
2011: 777 (16%); 
2012: 2,291 (48%). 

Median payment; 
2011: $1.6 million; 
2012: $1.4 million. 

Total payments; 
2011: $1.3 billion; 
2012: $3.5 billion. 

Source: GAO analysis of CMS data. 

Note: Figures are based on data CMS collected through July 2, 2013, 
for the 2011 and 2012 program years. 

[End of table] 

Nationwide, most of the hospitals (72 percent) that were awarded a 
Medicare EHR incentive payment for 2012 were new to the program--that 
is, they did not receive a payment for 2011. These hospitals make up 
34 percent of eligible hospitals nationwide. Connecticut had the 
largest percentage (53 percent) of eligible hospitals awarded 
incentive payments that were new to the program for 2012. 

Incentive payments to hospitals for 2012 ranged from a low of $4,827 
to a high of $4.7 million. The median payment amount was $1.4 million, 
a slight decrease from the median payment amount of $1.6 million for 
2011. (See figure 1.) This is because most of the 28 percent of 
hospitals that were awarded a Medicare EHR incentive payment for 2012 
received lower incentive payments for their second year of 
participation, as the formula reduces the potential incentive payment 
by 25 percent each year after an acute care hospital is first awarded 
a payment from the Medicare EHR program.[Footnote 18] 

Figure 1: Distribution of Medicare EHR Incentive Payment Amounts 
Awarded to Hospitals: 

[Refer to PDF for image: illustration] 

2011: 
Medicare EHR incentive payment amount: 
Minimum: $22,300; 
Median (25%-75% percentile): $1.6 million; 
Maximum: $4.4 million. 

2012: 
Medicare EHR incentive payment amount: 
Minimum: $4,827; 
Median (25%-75% percentile): $1.4 million; 
Maximum: $4.7 million. 

Source: GAO analysis of CMS data. 

Note: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. 

[End of figure] 

Hospital characteristics. We found that the characteristics of 
hospitals that were awarded an incentive payment for 2012 were similar 
to the characteristics of hospitals awarded an incentive payment for 
2011. Specifically among hospitals that were awarded an incentive 
payment for 2012, we found that: 

* the largest proportion (39 percent) was in the South, and the 
smallest proportion (15 percent) was in the West; 

* about three-fifths (61 percent) were in urban areas; 

* more than four-fifths (83 percent) were acute care hospitals; and: 

* three-fifths (60 percent) were nonprofit hospitals. 

For 2012, hospitals with certain characteristics were more likely to 
have been awarded a Medicare EHR incentive payment than other 
hospitals. For example, hospitals in the Northeast were 1.5 times more 
likely than hospitals in the West to have been awarded an incentive 
payment. Further, acute care hospitals were nearly twice as likely as 
critical access hospitals to have been awarded an incentive payment. 
The largest hospitals--those in the top third in terms of numbers of 
beds--were 2 times more likely than hospitals in the bottom third to 
have been awarded an incentive payment. 

Comparing 2012 to 2011, there were differences in the likelihood of 
hospitals with certain characteristics having been awarded incentive 
payments. For example, hospitals in rural areas were 3.1 times more 
likely to have been awarded an incentive payment for 2012 compared to 
2011, which was a slightly greater increase than for hospitals overall. 

Professional incentive payments. For 2012, 183,712 professionals were 
awarded a total of $2.8 billion in Medicare EHR incentive payments. 
[Footnote 19] These 183,712 professionals awarded payments for 2012 
represent 31 percent of the eligible professionals. They also 
represent an increase compared to 2011, when 58,331 professionals, or 
10 percent of those eligible, were awarded an incentive payment. (See 
table 2.) 

Table 2: Participation in the Medicare EHR Program by Professionals: 

Number (percentage of eligible); 
2011: 58,331 (10%); 
2012: 183,712 (31%). 

Median payment; 
2011: $18,000; 
2012: $18,000. 

Total payments; 
2011: $994.6 million; 
2012: $2.8 billion. 

Source: GAO analysis of CMS data. 

Note: Figures are based on data CMS collected through July 2, 2013, 
for the 2011 and 2012 program years. 

[End of table] 

Nationwide, most of the professionals (75 percent) who were awarded a 
Medicare EHR incentive payment for 2012 were new to the program. These 
professionals make up 23 percent of eligible professionals nationwide. 
South Dakota had the largest percentage (38 percent) of eligible 
professionals who were new to the program for 2012. 

The percentage of professionals who received the highest Medicare EHR 
incentive payment amount (i.e., $18,000 for 2012) decreased for 2012 
compared to 2011. (See figure 2.) This is because 2012 was the second 
year of participation for 25 percent of professionals and the maximum 
payment amount decreases over the 5 years in which professionals are 
eligible for payments. 

Figure 2: Percentage of Professionals Who Were Awarded Medicare EHR 
Incentive Payments, by Amount: 

[Refer to PDF for image: 2 pie-charts] 

2011: 
$18,000 or $19,800: 86%; 
Greater than or equal to $12,000, but less than $18,000: 5%; 
Less than $12,000: 9%. 

2012: 
$18,000: 63%; 
Greater than or equal to $12,000, but less than $18,000: 27%; 
Less than $12,000: 10%. 

Source: GAO analysis of CMS data. 

Note: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. The amount of the incentive payment for 
2011 and 2012 cannot exceed $18,000 for most professionals or $19,800 
for professionals who practice predominately in a health professional 
shortage area. The 2012 figure does not include the 10 percent 
additional payments for professionals who practice predominately in a 
health professional shortage area because CMS had not disbursed those 
payments as of the date of our analysis. 

[End of figure] 

Professional characteristics. We found that the characteristics of 
professionals who were awarded an incentive payment for 2012 were 
similar to the characteristics of professionals awarded an incentive 
payment for 2011. Specifically, among professionals who were awarded 
an incentive payment for 2012, we found that: 

* the largest proportion (32 percent) was in the South, and the 
smallest proportion (18 percent) was in the West; 

* a significant majority (90 percent) was in urban areas; 

* over half (56 percent) were specialty practice physicians, and over 
one-third (34 percent) were general practice physicians; 

* about half (44 percent) had relatively high amounts of 2012 Medicare 
Part B charges. 

For 2012, professionals with certain characteristics were more likely 
to have been awarded a Medicare EHR incentive payment than other 
professionals. For example, general practice physicians were 1.5 times 
more likely than specialty practice physicians to have been awarded an 
incentive payment. Professionals who had signed an agreement to 
receive technical assistance from a Regional Extension Center were 1.9 
times more likely to have been awarded an incentive payment than those 
who had not. Professionals in the top third in terms of Medicare Part 
B charges or number of Medicare Part B encounters were approximately 
2.5 times more likely to have been awarded an incentive payment 
compared to those in the bottom third for charges or number of 
encounters. 

Comparing 2012 to 2011, there were differences in the likelihood of 
professionals with certain characteristics having been awarded 
incentive payments. For example, professionals with the lowest total 
amount of Medicare Part B charges were 3.3 times more likely to have 
been awarded an incentive payment for 2012 compared to 2011, which was 
a slightly greater increase than for professionals overall. 

See enclosure II for more information on the characteristics of 
hospitals that were awarded a Medicare EHR incentive payment for 2012, 
including comparisons to those awarded payments for 2011. See 
enclosure III for more information on the characteristics of 
professionals who were awarded a Medicare EHR incentive payment for 
2012, including comparisons to those awarded payments for 2011. 

We provided a draft of this report to the Department of Health and 
Human Services for comment. In its response, the department stated 
that it had no comments. 

We are sending copies of this report to the Secretary of Health and 
Human Services, the Administrator of CMS, the National Coordinator for 
Health Information Technology, and other interested parties. In 
addition, the report will be available at no charge on GAO's website 
at [hyperlink, http://www.gao.gov]. If you or your staffs have any 
questions about this report, please contact me at (202) 512-7114 or at 
kohnl@gao.gov. Contact points for our Office of Congressional 
Relations and Office of Public Affairs can be found on the last page 
of this report. Major contributors to this report were William Simerl, 
Assistant Director; Julianne Flowers; Shannon Legeer; Hannah Marston 
Minter; Monica Perez Nelson; and Rebecca Rust Williamson. 

Signed by: 

Linda T. Kohn: 
Director, Health Care: 

Enclosures - 3: 

List of Committees: 

The Honorable Max Baucus: 
Chairman: 
The Honorable Orrin G. Hatch: 
Ranking Member: 
Committee on Finance: 
United States Senate: 

The Honorable Tom Harkin: 
Chairman: 
The Honorable Lamar Alexander: 
Ranking Member: 
Committee on Health, Education, Labor, and Pensions: 
United States Senate: 

The Honorable Tom Harkin: 
Chairman: 
The Honorable Jerry Moran: 
Ranking Member: 
Subcommittee on Labor, Health and Human Services, Education, and 
Related Agencies: 
Committee on Appropriations: 
United States Senate: 

The Honorable Fred Upton: 
Chairman: 
The Honorable Henry A. Waxman: 
Ranking Member: 
Committee on Energy and Commerce: 
House of Representatives: 

The Honorable Dave Camp: 
Chairman: 
The Honorable Sander M. Levin: 
Ranking Member: 
Committee on Ways and Means: 
House of Representatives: 

The Honorable Jack Kingston: 
Chairman: 
The Honorable Rosa DeLauro: 
Ranking Member: 
Subcommittee on Labor, Health and Human Services, Education, and 
Related Agencies: 
Committee on Appropriations: 
House of Representatives: 

[End of section] 

Enclosure I: Scope and Methodology: 

This enclosure provides additional details regarding our analysis of 
data from the Centers for Medicare & Medicaid Services (CMS) and other 
government sources to (1) determine the number of providers that were 
awarded a Medicare electronic health record (EHR) incentive payment; 
(2) estimate the percentage of eligible providers that were awarded a 
Medicare EHR incentive payment; (3) determine the amount of Medicare 
EHR incentive payments awarded to providers; and (4) examine the 
characteristics of providers that were awarded Medicare EHR incentive 
payments. In addition, this enclosure provides information on the 
analysis we conducted to present information on Medicare Advantage 
Organization (MAO) payments.[Footnote 20] 

Number of providers that were awarded a Medicare EHR incentive 
payment. To determine the number of providers that were awarded an 
incentive payment, we analyzed data on providers that were awarded 
Medicare EHR incentive payments for 2011 and 2012 from CMS's National 
Level Repository.[Footnote 21] We analyzed data related to the 2011 
and 2012 program years that CMS collected from January 3, 2011, 
through July 2, 2013. As a result, we generally included full-year 
information for both years in our analysis, since the second program 
year for hospitals ended on November 30, 2012, and the second program 
year for professionals ended on February 28, 2013.[Footnote 22] 
Specifically, we counted the number of providers that had an incentive 
payment disbursed to them. 

Estimate of the percentage of eligible providers that were awarded a 
Medicare EHR incentive payment. To estimate the nationwide percentage 
of eligible providers that were awarded an incentive payment in each 
year, we divided the number of providers that were awarded an 
incentive payment in the year by the total number of eligible 
providers in the same year. We identified eligible hospitals as those 
that fit the following four criteria: 

* were acute care hospitals or critical access hospitals; 

* were located in one of the 50 states or the District of Columbia; 

* were not terminated from participating in the Medicare program 
before October 1, 2010, for determining eligibility for 2011; or 
before October 1, 2011, for determining eligibility for 2012; and: 

* were not awarded an incentive payment from the Medicare Advantage 
Organization (MAO) EHR program during the same year.[Footnote 23] 

We identified eligible professionals as those that fit the following 
five criteria: 

* have specialty types that are eligible for the Medicare EHR program, 
which include all medical doctor/doctor of osteopathic medicine 
specialties, chiropractors, doctors of dental medicine or surgery, 
podiatrists, and optometrists; 

* were not hospital-based professionals; 

* had greater than $0 in Medicare Part B charges in 2010 for 
determining eligibility for 2011 or had greater than $0 in Medicare 
Part B charges in 2011 for determining eligibility for 2012; 

* were not awarded an incentive payment from the Medicare Advantage 
Organization (MAO) EHR program during the same year; and: 

* were not awarded an incentive payment from the Medicaid EHR program 
during the same year.[Footnote 24] 

We used a similar approach to estimate the percentage of eligible 
providers that were awarded an incentive payment for 2012 in each 
state. For those providers we also determined whether or not they were 
awarded a Medicare EHR payment for 2011. 

Amount of Medicare EHR incentive payments awarded to providers. We 
determined the total amount of the incentive payments that were 
awarded to providers each year by summing the Medicare EHR incentive 
payments that had been disbursed by CMS in each year. We also examined 
the distribution of the Medicare incentive payments across providers. 
Specifically, for hospitals, we determined the minimum, 25th 
percentile, median, 75th percentile, and maximum Medicare EHR 
incentive payment amounts. For professionals, we determined the 
percentage who were awarded an incentive payment amount of (a) greater 
than or equal to $18,000, but less than or equal to $19,800, (b) less 
than $18,000 but greater than or equal to $12,000, and (c) less than 
$12,000.[Footnote 25] 

Characteristics of providers that were awarded Medicare EHR incentive 
payments. To examine the characteristics of providers that were 
awarded Medicare EHR incentive payments for 2011 and 2012, we analyzed 
data on provider characteristics from CMS, the Health Resources and 
Services Administration, and the Office of the National Coordinator 
for Health Information Technology (ONC). (See table 3.) Each 
characteristic is divided into two or more categories. For example, 
the characteristic "geographic region" is divided into four 
categories--Midwest, Northeast, South, and West regions. As part of 
this analysis, we also compared the characteristics of providers that 
were awarded a Medicare EHR incentive payment in a given year to those 
of eligible providers that were not awarded such payments in the same 
year. To do so, we calculated relative risk ratios that indicate how 
much more likely a provider in each category was to have been awarded 
an EHR incentive payment in a given year than a provider in the 
category that was least likely to have been awarded a payment in the 
same year. 

Table 3: Data Sources Analyzed to Examine Characteristics of Eligible 
Providers: 

Agency or entity: CMS; 
Data source: National Level Repository; 
Date of extract, download, or release for 2011: July 2013; 
Date of extract, download, or release for 2012: July 2013. 

Agency or entity: CMS; 
Data source: 2010 and 2011 Medicare Part B claims; 
Date of extract, download, or release for 2011: January - December 
2010; 
Date of extract, download, or release for 2012: January - December 
2011. 

Agency or entity: CMS; 
Data source: National Plan and Provider Enumeration System Data 
Dissemination File[A]; 
Date of extract, download, or release for 2011: May 2012; 
Date of extract, download, or release for 2012: January 2013. 

Agency or entity: CMS; 
Data source: Provider Enrollment, Chain, and Ownership System[A]; 
Date of extract, download, or release for 2011: August 2012; 
Date of extract, download, or release for 2012: April 2013. 

Agency or entity: CMS; 
Data source: Provider of Services File; 
Date of extract, download, or release for 2011: January 2012; 
Date of extract, download, or release for 2012: March 2013. 

Agency or entity: CMS; 
Data source: Hospital Compare; 
Date of extract, download, or release for 2011: January 2013; 
Date of extract, download, or release for 2012: January 2013. 

Agency or entity: CMS; 
Data source: Healthcare Cost Report Information System; 
Date of extract, download, or release for 2011: March and June 2013[B]; 
Date of extract, download, or release for 2012: March and June 2013[B]. 

Agency or entity: CMS; 
Data source: Integrated Data Repository; 
Date of extract, download, or release for 2011: April 2013[C]; 
Date of extract, download, or release for 2012: April 2013[C]. 

Agency or entity: CMS; 
Data source: 2010 and 2011 Primary Care Health Professional Shortage 
Areas; 
Date of extract, download, or release for 2011: November 2010; 
Date of extract, download, or release for 2012: July 2012. 

Agency or entity: Health Resources and Services Administration; 
Data source: Area Resource File; 
Date of extract, download, or release for 2011: March 2012; 
Date of extract, download, or release for 2012: March 2012. 

Agency or entity: Office of the National Coordinator for Health 
Information Technology; 
Data source: Regional Extension Center Customer Relationship 
Management System extract file[D]; 
Date of extract, download, or release for 2011: April 2013[E]; 
Date of extract, download, or release for 2012: April 2013[E]. 

Agency or entity: Office of the National Coordinator for Health 
Information Technology; 
Data source: List of zip codes serviced by a Beacon Community[F]; 
Date of extract, download, or release for 2011: March 2012; 
Date of extract, download, or release for 2012: April 2013. 

Source: GAO. 

[A] Data contained in this data source are generally self-reported by 
providers to CMS. 

[B] We combined the data obtained in the two extracts. For 2011 we 
used the most recent record for a hospital with a cost report end date 
prior to May 1, 2012, and for 2012 we used the most recent record 
available. 

[C] The 2011 file is based on Medicare Part B claims from fiscal year 
2010 (October 1, 2009, to September 30, 2010), and the 2012 file is 
based on Medicare Part B claims from fiscal year 2011 (October 1, 
2010, to September 30, 2011). 

[D] The Regional Extension Center program was established by the 
Health Information Technology for Economic and Clinical Health Act and 
is administered by the Office of the National Coordinator for Health 
Information Technology to help some types of providers, such as those 
located in rural areas, to participate in CMS's EHR programs. 

[E] For 2011, we categorized professionals as having signed an 
agreement if they did so before January 1, 2012. For 2012, we 
categorized professionals as having signed an agreement if they did so 
before January 1, 2013. 

[F] The Office of the National Coordinator for Health Information 
Technology provided funding to support 17 Beacon Communities to build 
and strengthen their health information technology infrastructure and 
exchange capabilities. These communities were selected for various 
reasons, including the progress they had already made in adopting 
EHRs. The 17 Beacon Communities focus on specific and measurable 
improvement goals in three areas for health systems improvement--
quality, cost-efficiency, and population health--to demonstrate the 
ability of health information technology to affect local health care 
systems. 

[End of table] 

Using the data obtained from the sources listed in table 3, we 
examined the following provider characteristics: 

* Regional characteristics. We analyzed data on the following regional 
characteristics: [Footnote 26] 

- Geographic region. We used the Health Resources and Services 
Administration's Area Resource File to identify the U.S. census 
region--Midwest, Northeast, South, or West--where providers were 
located or practiced. 

- Location. We used the Health Resources and Services Administration's 
Area Resource File to determine whether providers were located in a 
metropolitan area--an area that has at least one urbanized area of 
50,000 people. We then categorized providers in metropolitan areas as 
being located in urban areas and providers that were not as being in 
rural areas. 

- Whether a provider is in a county with a Beacon Community. We used 
data from ONC to categorize providers as either being in a Beacon 
Community or not.[Footnote 27] 

- Whether a professional practices in a health professional shortage 
area. We used the list from CMS that identifies the zip codes that 
were designated as primary care health professional shortage areas for 
bonus payments to categorize providers as either being in a health 
professional shortage area or not.[Footnote 28] 

* Hospital type. We analyzed data on the following categorizations of 
hospital type: 

- Hospital classification. We determined whether hospitals were 
classified as acute care hospitals or critical access hospitals by 
using data from CMS's Provider of Services file. 

- Major teaching hospital. We determined whether or not hospitals were 
listed as having a major affiliation with a medical school in CMS's 
Provider of Services file. 

- Ownership type. We used data on ownership type from CMS's Provider 
of Services file to create three categories of ownership: (a) for-
profit by combining private for-profit and physician ownership, (b) 
nonprofit by combining church and private not-for-profit, and (c) 
government-owned by combining four government designations (federal, 
state, local, and hospital district or authority) and tribal. In 
instances in which ownership type was listed as "other" in the 
Provider of Services file, we obtained information needed to classify 
hospitals as for-profit, nonprofit, or government-owned from another 
CMS data source--Hospital Compare. 

- Chain membership. We categorized hospitals as being a member of a 
chain if the hospital has a chain home office listed in CMS's Provider 
Enrollment, Chain, and Ownership System. All other hospitals with a 
record in CMS's Provider Enrollment, Chain, and Ownership System were 
designated as not being a member of a chain.[Footnote 29] 

* Hospital size. We analyzed the following measures of hospital size 
from CMS's Provider of Services file and Healthcare Cost Report 
Information System:[Footnote 30] 

- Total beds. Using data from CMS's Provider of Services file on the 
total number of hospital beds, we created three categories for each 
year: (a) low--less than or equal to the 33.3rd percentile, (b) 
middle--greater than the 33.3rd percentile but less than or equal to 
the 66.7th percentile, and (c) high--greater than the 66.7th 
percentile. 

- Medicare inpatient bed days. Using data from CMS's Healthcare Cost 
Report Information System, for each hospital we counted the number of 
Medicare inpatient bed days.[Footnote 31] Using these aggregated data, 
we created three categories for each year, utilizing the same 
percentile-based methodology used to categorize total beds. 

- Total discharges. Using data from CMS's Healthcare Cost Report 
Information System on the total number of discharges for each 
hospital, we created three categories for each year, utilizing the 
same percentile-based methodology used to categorize total beds. 

* Hospital charges. We analyzed data on the following measures of 
hospital charges from CMS's Healthcare Cost Report Information System: 

- Total charges. Using data on the total amount of charges, we created 
three categories for each year, utilizing the same percentile-based 
methodology used to categorize total beds.[Footnote 32] 

- Charity charges. Using data on charity charges, we created three 
categories for each year, utilizing the same percentile-based 
methodology used to categorize total beds.[Footnote 33] 

* Professional characteristics. We included in our analysis the 
following four types of professional characteristics: 

- Professional specialty. We primarily obtained data on professionals' 
primary specialty from CMS's National Plan and Provider Enumeration 
System Downloadable File. Then, with the assistance of a crosswalk 
that we obtained from CMS that aggregates specialty taxonomy codes 
into a smaller number of specialties, we created the following six 
categories: (a) general practice physician, (b) specialty practice 
physician, (c) chiropractor, (d) dentist, (e) optometrist, and (f) 
podiatrist.[Footnote 34] In instances in which the professional 
specialty information was missing from the National Plan and Provider 
Enumeration System, we obtained information on professionals' 
specialty from another CMS data source--the Provider Enrollment, 
Chain, and Ownership System. To examine variation among different 
types of specialty practice physicians, we used information from the 
CMS crosswalk to assign specialty practice physicians to one of 27 
specialty categories, such as cardiology, surgery, and psychiatry. 
Professionals who had missing information on professional specialty in 
both data sources and had not been awarded a Medicare EHR incentive 
payment for 2011 or 2012 were dropped from our analysis for the 
respective year, since we were unable to determine whether they were 
eligible to receive an incentive payment.[Footnote 35] 

- Whether the professional had signed an agreement to receive 
technical assistance from a Regional Extension Center. We obtained 
data from ONC's Regional Extension Center Customer Relationship 
Management System on whether professionals (identified by National 
Provider Identifier) had signed an agreement to receive technical 
assistance from a Regional Extension Center.[Footnote 36] We then 
categorized professionals as either having signed an agreement to 
receive technical assistance or not. For 2011, we categorized 
professionals as having signed an agreement if they did so before 
January 1, 2012. For 2012, we categorized professionals as having 
signed an agreement if they did so before January 1, 2013. 

- Years since the professional's degree was awarded. Using data on 
when professionals had received their degree from CMS's Provider 
Enrollment, Chain, and Ownership System, we determined the number of 
years since each professional's degree was awarded.[Footnote 37] We 
subsequently created three categories: (a) low--less than or equal to 
15 years, (b) middle--greater than 15 years but less than or equal to 
29 years, and (c) high--30 years or more.[Footnote 38] 

* Professional practice size. We analyzed data on the following three 
measures of practice size from CMS's calendar year 2010 Medicare Part 
B claims or 2011 Medicare Part B claims: [Footnote 39] 

- Total amount of Medicare Part B charges. For each professional 
(identified by National Provider Identifier), we summed the amount of 
Medicare Part B charges over the year. For 2011 we used 2010 claims, 
and for 2012 we used 2011 claims. Subsequently, we created three 
categories by aggregating total charges by professional for each year, 
utilizing the same percentile-based methodology used to categorize 
total beds.[Footnote 40] 

- Total number of Medicare Part B encounters. For each professional 
(identified by National Provider Identifier), we counted the number of 
Medicare Part B encounters--that is, distinct Medicare patient visits. 
For 2011 we used 2010 claims, and for 2012 we used 2011 claims. 
Subsequently, we created three categories by aggregating total 
encounters by professional for each year, utilizing the same 
percentile-based methodology used to categorize total beds.[Footnote 
41] 

- Number of professionals in the practice. We estimated the number of 
professionals in each practice by counting the number of professionals 
who were listed as members of each professional practice in CMS's 
Provider Enrollment, Chain, and Ownership System. We subsequently 
created four practice size categories: (a) solo practice, (b) practice 
of 2 to 10 professionals, (c) practice of 11 to 50 professionals, and 
(d) practice of 51 or more professionals. We also created a fifth 
category for professionals who were associated with more than one 
group practice of different sizes.[Footnote 42] 

Number of providers that were awarded a Medicare Advantage 
Organization (MAO) EHR incentive payment and the amount of MAO EHR 
incentive payments awarded. To determine the number of providers that 
were awarded an MAO EHR incentive payment and total amount of payments 
awarded, we analyzed data related to the 2011 and 2012 program years 
that CMS collected from January 3, 2011, through July 2, 2013, in its 
National Level Repository. Specifically, we counted the number of 
providers that had an MAO EHR incentive payment disbursed to them, and 
we summed the MAO EHR incentive payments that had been disbursed in 
each year.[Footnote 43] 

In July 2012 we reported information on providers that were awarded 
Medicare EHR incentive payments for 2011, including the number of 
award recipients and their characteristics.[Footnote 44] In 
constructing the analyses for this report, we made some refinements to 
the methodology utilized in the July 2012 report.[Footnote 45] For 
example, we analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013, which includes payments made for both 
2011 and 2012. In addition, we used data from CMS's Healthcare Cost 
Report Information System instead of from CMS's Fiscal Intermediary 
Standard System to present the following information for hospitals: 
Medicare inpatient bed days, total discharges, total charges, and 
charity charges. We made this change to reduce the number of hospitals 
for which we were missing data. We also excluded from the counts of 
eligible hospitals (presented in enclosure II) those hospitals that 
received incentive payments from the MAO EHR program. In addition, we 
excluded from the counts of eligible professionals (presented in 
enclosure III) professionals affiliated with MAOs that received 
incentive payments from the MAO EHR program and professionals that 
received incentive payments from the Medicaid EHR program.[Footnote 
46] We made these changes to better reflect the population of 
providers who were eligible for the Medicare EHR program in the given 
year. 

To ensure the reliability of the various data we analyzed, we 
interviewed officials from CMS and ONC; reviewed relevant 
documentation; and conducted electronic testing to identify missing 
data and obvious errors. On the basis of these activities, we 
determined that the data we analyzed were sufficiently reliable for 
our analysis. Although the amount of missing data was generally low, 
we noted instances in which data were missing for 6 percent of 
providers or more. 

We conducted this performance audit from April 2013 to October 2013 in 
accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe 
that the evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives. 

[End of section] 

Enclosure II: Information on Hospitals That Were Awarded Medicare: 

EHR Incentive Payments for 2012 and 2011: 

This enclosure provides information on the amount of Medicare EHR 
incentive payments awarded to hospitals for 2012, the number and 
percentage of hospitals that were awarded incentive payments, and the 
characteristics of hospitals that were awarded incentive payments. 
This enclosure also compares different categories of eligible 
hospitals to determine which were more likely and which were less 
likely for 2012 to have been awarded an incentive payment. In some 
cases, information on Medicare EHR incentive payments awarded to 
hospitals for 2011 is presented for comparison. In addition, this 
enclosure compares the characteristics of hospitals awarded incentive 
payments for 2012 to the characteristics of hospitals awarded 
incentive payments for 2011. 

Of the estimated 4,806 eligible hospitals, 48 percent, or 2,291 
hospitals, were awarded a Medicare EHR incentive payment for 
2012.[Footnote 47] The percentage of eligible hospitals that were 
awarded a Medicare EHR incentive payment varied by state for 2012. For 
example, more than 80 percent of eligible hospitals in Rhode Island 
were awarded a Medicare EHR incentive payment for 2012, whereas less 
than 15 percent of eligible hospitals in the District of Columbia were 
awarded an incentive payment for 2012. In 18 states, the percentage of 
eligible hospitals that received incentive payments for 2012 was 50 
percent or more (see figure 3). 

Figure 3: Percentage of Eligible Hospitals That Were Awarded a 
Medicare EHR Incentive Payment for 2012 Alone and for Both 2011 and 
2012, by State: 

[Refer to PDF for image: stacked horizontal bar graph] 

The nationwide average percentage of hospitals awarded an incentive 
payment for 2012: 48%. 

State: Rhode Island; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 36.4%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 45.5%. 

State: Florida; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 39.7%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 29.9%. 

State: New Hampshire; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 46.2%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 23.1%. 

State: Connecticut; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 53.1%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 12.5%. 

State: Massachusetts; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 39.4%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 22.7%. 

State: New Jersey; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 49.2%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 12.3%. 

State: Missouri; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 41.1%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 18.8%. 

State: Indiana; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 48.8%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 10.4%. 

State: Virginia; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 22.7%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 36.4%. 

State: New York; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 46%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 10.7%. 

State: Pennsylvania; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 42.7%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 13.5%. 

State: Kentucky; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 46.8%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 8.5%. 

State: Alabama; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 37.8%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 17.4%. 

State: South Carolina; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 45.2%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 9.7%. 

State: Georgia; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 34%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 19.2%. 

State: Maryland; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 43.5%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 8.7%. 

State: Colorado; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 39.5%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 11.8%. 

State: Wisconsin; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 45.2%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 4.8%. 

State: Illinois; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 31.7%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 17.8%. 

State: Iowa; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 35.4%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 13.8%. 

State: Mississippi; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 36.3%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 12.8%. 

State: New Mexico; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 48.8%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 0. 

State: Michigan; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 29.4%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 18.4%. 

State: Arizona; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 46.3%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 1.3%. 

State: Minnesota; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 31.3%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 16%. 

State: Arkansas; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 26.7%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 20%. 

State: Ohio; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 33.7%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 11.4%. 

State: Texas; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 25.7%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 19.1%. 

State: Maine; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 27.8%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 16.7%. 

State: Louisiana; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 29.5%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 14.7%. 

State: Vermont; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 42.9%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 0. 

State: South Dakota; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 41%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 1.6%. 

State: Tennessee; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 30.3%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 12.3%. 

State: California; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 34.5%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 7.3%. 

State: Kansas; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 28.8%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 11.5%. 

State: Nevada; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 31.4%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 8.6%. 

State: West Virginia; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 33.3%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 5.9%. 

State: North Dakota; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 36.4%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 0. 

State: Montana; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 32.8%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 3.3%. 

State: Nebraska; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 27%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 9%. 

State: Oklahoma; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 28.1%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 5.5%. 

State: Washington; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 25.3%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 8.1%. 

State: North Carolina; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 26.8%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 6.3%. 

State: Hawaii; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 18.2%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 13.6%. 

State: Idaho; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 22%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 9.8%. 

State: Oregon; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 21.1%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 7%. 

State: Utah; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 14%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 14%. 

State: Wyoming; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 26%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 0. 

State: Alaska; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 13.6%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 4.6%. 

State: Delaware; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 0; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 16.7%. 

State: District of Columbia; 
Percent of 2012 Participating Hospitals That Participated Only on 
2012: 14.3%; 
Percent of 2012 Participating Hospitals That Participated on 2011 And 
2012: 0. 

Source: GAO analysis of CMS data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. This figure illustrates the percentage 
of eligible hospitals that were awarded Medicare EHR incentive 
payments for 2012 by state, as indicated in the full length of each 
bar. These bars are divided to indicate the percentage of eligible 
hospitals that were awarded an incentive payment only for 2012, 
designated by the darker shading, and the percentage of eligible 
hospitals that were awarded an incentive payment for both 2011 and 
2012, designated by the lighter shading. No hospitals in the District 
of Columbia received payments for 2011. 

[End of figure] 

Nationwide, most of the hospitals (72 percent) that were awarded a 
Medicare EHR incentive payment for 2012 were new to the program--that 
is, they did not receive a payment for 2011--with substantial 
variation among states. These hospitals make up 34 percent of eligible 
hospitals nationwide. Connecticut had the largest percentage (53 
percent) of eligible hospitals that were new to the Medicare EHR 
incentive program for 2012, meaning they did not receive a payment for 
2011. Additionally, almost all hospitals that received Medicare EHR 
incentive payments for 2012 in Arizona were new to the program for 
2012. In contrast, less than half of the hospitals in Virginia that 
received incentive payments for 2012 were new to the program. While 
many hospitals were new to the program for 2012, 18 percent of the 
hospitals that were awarded a Medicare EHR incentive payment for 2011 
were not awarded a payment for 2012. 

Of the $6.3 billion in Medicare EHR incentive payments that were 
awarded to providers for 2012, a total of $3.5 billion was awarded to 
hospitals. The amount of Medicare EHR incentive payments awarded to 
hospitals ranged from $4,827 to $4.7 million, with the median amount 
being $1.4 million. Sixty percent of hospitals that were awarded an 
incentive payment accounted for 80 percent of the total amount of 
incentive payments awarded to hospitals. Acute care hospitals tended 
to receive larger incentive payments than critical access hospitals. 
(See figure 4.) 

Figure 4: Distribution of Medicare EHR Incentive Payment Amounts 
Awarded to Hospitals for 2012, by Selected Hospital Characteristics: 

[Refer to PDF for image: illustration] 

Overall: 
Medicare EHR incentive payment amount: 
Minimum: $4,827; 
Median (25%-75% percentile): $1.4 million; 
Maximum: $4.7 million. 

Location: Rural: 
Medicare EHR incentive payment amount: 
Minimum: $4,827; 
Median (25%-75% percentile): $1.1 million; 
Maximum: $4.7 million. 

Location: Urban: 
Medicare EHR incentive payment amount: 
Minimum: $49.246; 
Median (25%-75% percentile): $1.7 million; 
Maximum: $4.5 million. 

Classification: Acute Care[A]: 
Medicare EHR incentive payment amount: 
Minimum: $124,600; 
Median (25%-75% percentile): $1.6 million; 
Maximum: $4.5 million. 

Classification: Critical access[B]: 
Medicare EHR incentive payment amount: 
Minimum: $4,827; 
Median (25%-75% percentile): $414,484; 
Maximum: $4.7 million. 

Ownership type: For-profit: 
Medicare EHR incentive payment amount: 
Minimum: $157,093; 
Median (25%-75% percentile): $1.4 million; 
Maximum: $4.0 million. 

Ownership type: Government-owned: 
Medicare EHR incentive payment amount: 
Minimum: $5,700; 
Median (25%-75% percentile): $1.1 million; 
Maximum: $3.7 million. 

Ownershipt type: Nonprofit: 
Medicare EHR incentive payment amount: 
Minimum: $4,827; 
Median (25%-75% percentile): $1.7 million; 
Maximum: $4.7 million. 

Source: GAO analysis of CMS and Health Resources and Services 
Administration data. 

Note: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. 

[A] Acute care hospitals are hospitals described in Section 1886(d) of 
the Social Security Act, which are paid under the inpatient 
prospective payment system. 

[B] Critical access hospitals typically are very small (25 inpatient 
beds or fewer) and operate in rural areas. 

[End of figure] 

As illustrated in figure 5, the characteristics among hospitals that 
were awarded a Medicare EHR incentive payment for 2012 are similar to 
those among hospitals awarded a Medicare EHR incentive payment for 
2011. Specifically, for 2012, 

* the largest proportion (39 percent) was in the South, and the 
smallest proportion (15 percent) was in the West; 

* about three-fifths (61 percent) were in urban areas; 

* more than four-fifths (83 percent) were acute care hospitals; and: 

* three-fifths (60 percent) were nonprofit hospitals. 

Figure 5: Selected Characteristics of Hospitals That Were Awarded a 
Medicare EHR Incentive Payment for 2011 and 2012: 

[Refer to PDF for image: 4 vertical bar graphs] 

Region: 

Northeast; 
2011: 11.8%; 
2012: 15.4%. 

South; 
2011: 45.4%; 
2012: 39.3%. 

Midwest; 
2011: 31%; 
2012: 30.1%. 

West; 
2011: 11.7%; 
2012: 15.2%. 

Location: 

Rural; 
2011: 36.3%; 
2012: 38.5%. 

Urban; 
2011: 63.2%; 
2012: 60.8%. 

Hospital classification: 

Acute care hospital[A]; 
2011: 80.6%; 
2012: 83.2%. 

Critical access hospital[B]; 
2011: 19.4%; 
2012: 16.9%. 

Partnership type: 

For-profit; 
2011: 22.4%; 
2012: 18.1%. 

Government-owned; 
2011: 24.1%; 
2012: 22.1%. 

Nonprofit; 
2011: 53.5%; 
2012: 59.7%. 

Source: GAO analysis of CMS and Health Resources and Services 
Administration data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. For a given year, the sum of the 
percentages of hospitals listed for a given characteristic may not 
equal 100 percent due to missing data or rounding. 

[A] Acute care hospitals are hospitals described in Section 1886(d) of 
the Social Security Act, which are paid under the inpatient 
prospective payment system. 

[B] Critical access hospitals typically are very small (25 inpatient 
beds or fewer) and operate in rural areas. 

[End of figure] 

Tables 4 through 7 compare the characteristics of hospitals that were 
awarded Medicare EHR incentive payments for 2012 and 2011 to those of 
other eligible Medicare hospitals that did not receive a payment for 
those years. Each characteristic is divided into two or more 
categories. For example, the characteristic "geographic region" is 
divided into four categories--Midwest, Northeast, South, and West. As 
part of this analysis, we calculated relative risk ratios that 
indicate how much more likely a hospital in each category was to have 
been awarded an EHR incentive payment in a given year than a hospital 
in the category that was least likely to have been awarded a payment 
for the same year. The categories in which hospitals were least likely 
to receive an incentive payment for the year are labeled [Empty]. For 
example, as table 4 shows, under the characteristic "geographic 
region" for 2012, the relative risk ratio of 1.5 for the category 
"Northeast" indicates that, for 2012, hospitals in the Northeast were 
1.5 times more likely to have been awarded an incentive payment than 
hospitals in the West, which were the least likely to receive an 
incentive payment. A relative risk ratio of 1.0 indicates no 
difference in the likelihood of having been awarded an incentive 
payment between the two categories for the given year, and, as 
relative risk ratios approach 1.0, there is less and less difference 
in the likelihood of having been awarded an incentive payment between 
the two categories. 

Table 4 shows the relationship between hospitals receiving Medicare 
EHR incentive payments for 2012 and the regions in which the hospitals 
are located. We found the following: 

* Geographic region had a modest effect on the likelihood that 
hospitals were awarded an EHR incentive payment for 2012. For 
instance, hospitals in the Northeast--the region with the highest 
percentage of hospitals awarded an incentive payment for 2012--were 
1.5 times more likely to have been awarded a payment than hospitals in 
the West--the region with the lowest percentage of hospitals awarded 
an incentive payment in the same year. 

* Urban or rural location also had a small effect on the likelihood 
that hospitals were awarded an EHR incentive payment for 2012. 
Specifically, for 2012, hospitals in urban areas were slightly (1.2 
times) more likely to have been awarded a payment compared to 
hospitals in rural areas. 

As indicated in table 4, the relationship between hospitals receiving 
Medicare EHR incentive payments and characteristics of the regions in 
which the hospitals are located is similar for both 2011 and 2012. 
However, the region where hospitals were most likely to receive an EHR 
incentive payment shifted from the South for 2011 to the Northeast for 
2012. 

Table 4: Number and Percentage of Hospitals That Were Awarded Medicare 
EHR Incentive Payments for 2011 and 2012, by Regional Characteristics: 

Characteristics: Overall; 
2011: 
Number of eligible hospitals[A]: 4,825; 
Number (percentage) awarded a Medicare EHR incentive payment: 777 
(16.1%); 
Relative risk ratio[B]: N/A; 
2012: 
Number of eligible hospitals[A]: 4,806; 
Number (percentage) awarded a Medicare EHR incentive payment: 2,291 
(47.7%); 
Relative risk ratio[B]: N/A. 

Characteristics: Geographic region; 
Categories: Midwest; 
2011: 
Number of eligible hospitals[A]: 1,460; 
Number (percentage) awarded a Medicare EHR incentive payment: 241 
(16.5%); 
Relative risk ratio[B]: 1.6; 
2012: 
Number of eligible hospitals[A]: 1,454; 
Number (percentage) awarded a Medicare EHR incentive payment: 689 
(47.4%); 
Relative risk ratio[B]: 1.2. 

Characteristics: Geographic region; 
Categories: Northeast; 
2011: 
Number of eligible hospitals[A]: : 607; 
Number (percentage) awarded a Medicare EHR incentive payment: 92 
(15.2%); 
Relative risk ratio[B]: 1.5; 
2012: 
Number of eligible hospitals[A]: 608; 
Number (percentage) awarded a Medicare EHR incentive payment: 353 
(58.1%); 
Relative risk ratio[B]: 1.5. 

Characteristics: Geographic region; 
Categories: South; 
2011: 
Number of eligible hospitals[A]: 1,866; 
Number (percentage) awarded a Medicare EHR incentive payment: 353 
(18.9%); 
Relative risk ratio[B]: 1.9; 
2012: 
Number of eligible hospitals[A]: 1,858; 
Number (percentage) awarded a Medicare EHR incentive payment: 900 
(48.4%); 
Relative risk ratio[B]: 1.2. 

Characteristics: Geographic region; 
Categories: Location: West; 
2011: 
Number of eligible hospitals[A]: Location: 892; 
Number (percentage) awarded a Medicare EHR incentive payment: 91 
(10.2%); 
Relative risk ratio[B]: Location: [Empty]; 
2012: 
Number of eligible hospitals[A]: Location: 886; 
Number (percentage) awarded a Medicare EHR incentive payment: 349 
(39.4%); 
Relative risk ratio[B]: Location: [Empty]. 

Characteristics: Location; 
Categories: Rural; 
2011: 
Number of eligible hospitals[A]: 2,072; 
Number (percentage) awarded a Medicare EHR incentive payment: 282 
(13.6%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible hospitals[A]: 2,064; 
Number (percentage) awarded a Medicare EHR incentive payment: 882 
(42.7%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Location; 
Categories: Urban; 
2011: 
Number of eligible hospitals[A]: 2,723; 
Number (percentage) awarded a Medicare EHR incentive payment: 491 
(18.0%); 
Relative risk ratio[B]: 1.3; 
2012: 
Number of eligible hospitals[A]: 2,714; 
Number (percentage) awarded a Medicare EHR incentive payment: 1,393 
(51.2%); 
Relative risk ratio[B]: 1.2. 

Characteristics: Located in a county with a Beacon Community; 
Categories: Yes; 
2011: 
Number of eligible hospitals[A]: 295; 
Number (percentage) awarded a Medicare EHR incentive payment: 43 
(14.6%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible hospitals[A]: 281; 
Number (percentage) awarded a Medicare EHR incentive payment: 131 
(46.6%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Located in a county with a Beacon Community; 
Categories: No; 
2011: 
Number of eligible hospitals[A]: 4,530; 
Number (percentage) awarded a Medicare EHR incentive payment: 734 
(16.2%); 
Relative risk ratio[B]: 1.1; 
2012: 
Number of eligible hospitals[A]: 4,525; 
Number (percentage) awarded a Medicare EHR incentive payment: 2,160 
(47.7%); 
Relative risk ratio[B]: 1.0. 

Source: GAO analysis of CMS, Office of the National Coordinator for 
Health Information Technology, and Health Resources and Services 
Administration data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. We compared the characteristics of the 
hospitals that were awarded a Medicare EHR incentive payment for 2012 
and for 2011 to those of other eligible hospitals that were not 
awarded a payment in the same year. The sum of the number of hospitals 
listed by category may not equal the overall number of hospitals due 
to missing data. 

[A] We use the term eligible hospitals to refer to those hospitals 
that were eligible for the Medicare EHR program, regardless of whether 
they were awarded a Medicare EHR incentive payment for 2011 and 2012. 
Specifically, eligible hospitals are those that were (1) acute care 
hospitals or critical access hospitals; (2) located in one of the 50 
states or the District of Columbia; (3) were not terminated from 
participating in the Medicare program before October 1, 2010, for 
determining eligibility for 2011; or on or before October 1, 2011, for 
determining eligibility for 2012; and (4) were not awarded an 
incentive payment from the Medicare Advantage Organization (MAO) EHR 
program during the same year. 

[B] The relative risk ratios indicate how much more likely a hospital 
in each category was to have been awarded an EHR incentive payment 
than a hospital in the category that was least likely to have been 
awarded a payment, which is labeled [Empty]. A relative risk ratio of 
1.0 indicates no difference in the likelihood of having been awarded 
an incentive payment between the two categories, and, as relative risk 
ratios approach 1.0, there is less and less difference in the 
likelihood of having been awarded an incentive payment between the two 
categories. 

[End of table] 

Table 5 shows the relationship between receiving a Medicare EHR 
incentive payment for 2012 and hospital type. We found the following: 

* Hospital classification had a greater effect on the likelihood of 
receiving a Medicare EHR incentive payment for 2012 than being a major 
teaching hospital, ownership type, and chain membership. In 
particular, among the two hospital classifications, acute care 
hospitals were nearly twice as likely for 2012 to have been awarded an 
incentive payment than critical access hospitals. 

* Being a major teaching hospital, ownership type, and chain 
membership had small effects on the likelihood that hospitals were 
awarded a Medicare EHR incentive payment for 2012. For example, major 
teaching hospitals were 1.3 times more likely to have received a 
payment than hospitals that were not major teaching hospitals. 

The effects of hospital classification, being a major teaching 
hospital, and chain membership were generally similar for 2011 
compared to for 2012. However, for 2012 the effect of hospital 
classification was greater than for 2011, and the effects associated 
with ownership type and chain membership largely disappeared. 

Table 5: Number and Percentage of Hospitals That Were Awarded Medicare 
EHR Incentive Payments for 2011 and 2012, by Hospital Type: 

Characteristics: Overall; 
2011: 
Number of eligible hospitals[A]: 4,825; 
Number (percentage) awarded a Medicare EHR incentive payment: 777 
(16.1%); 
Relative risk ratio[B]: N/A; 
2012: 
Number of eligible hospitals[A]: 4,806; 
Number (percentage) awarded a Medicare EHR incentive payment: 2,291 
(47.7%); 
Relative risk ratio[B]: N/A. 

Characteristics: Hospital classification; 
Categories: Acute care hospital[C]; 
2011: 
Number of eligible hospitals[A]: 3,494; 
Number (percentage) awarded a Medicare EHR incentive payment: 626 
(17.9%); 
Relative risk ratio[B]: 1.6; 
2012: 
Number of eligible hospitals[A]: 3,472; 
Number (percentage) awarded a Medicare EHR incentive payment: 1,905 
(54.9%); 
Relative risk ratio[B]: 1.9. 

Characteristics: Hospital classification; 
Categories: Critical access hospital[D]; 
2011: 
Number of eligible hospitals[A]: 1,331; 
Number (percentage) awarded a Medicare EHR incentive payment: 151 
(11.3%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible hospitals[A]: 1,334; 
Number (percentage) awarded a Medicare EHR incentive payment: 386 
(28.9%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Major teaching hospital; 
Categories: Yes; 
2011: 
Number of eligible hospitals[A]: 427; 
Number (percentage) awarded a Medicare EHR incentive payment: 88 
(20.6%); 
Relative risk ratio[B]: 1.3; 
2012: 
Number of eligible hospitals[A]: 429; 
Number (percentage) awarded a Medicare EHR incentive payment: 266 
(62.0%); 
Relative risk ratio[B]: 1.3. 

Characteristics: Major teaching hospital; 
Categories: No; 
2011: 
Number of eligible hospitals[A]: 4,398; 
Number (percentage) awarded a Medicare EHR incentive payment: 689 
(15.7%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible hospitals[A]: 4,377; 
Number (percentage) awarded a Medicare EHR incentive payment: 2,025 
(46.3%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Ownership type; 
Categories: For-profit; 
2011: 
Number of eligible hospitals[A]: 840; 
Number (percentage) awarded a Medicare EHR incentive payment: 174 
(20.7%); 
Relative risk ratio[B]: 1.4; 
2012: 
Number of eligible hospitals[A]: 846; 
Number (percentage) awarded a Medicare EHR incentive payment: 415 
(49.1%); 
Relative risk ratio[B]: 1.1. 

Characteristics: Ownership type; 
Categories: Government-owned; 
2011: 
Number of eligible hospitals[A]: 1,221; 
Number (percentage) awarded a Medicare EHR incentive payment: 187 
(15.3%); 
Relative risk ratio[B]: 1.0; 
2012: 
Number of eligible hospitals[A]: 1,182; 
Number (percentage) awarded a Medicare EHR incentive payment: 507 
(42.9%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Ownership type; 
Categories: Nonprofit; 
2011: 
Number of eligible hospitals[A]: 2,744; 
Number (percentage) awarded a Medicare EHR incentive payment: 416 
(15.2%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible hospitals[A]: 2,764; 
Number (percentage) awarded a Medicare EHR incentive payment: 1,367 
(49.5%); 
Relative risk ratio[B]: 1.2. 

Characteristics: Chain membership; 
Categories: Chain; 
2011: 
Number of eligible hospitals[A]: 1,552; 
Number (percentage) awarded a Medicare EHR incentive payment: 313 
(20.2%); 
Relative risk ratio[B]: 1.3; 
2012: 
Number of eligible hospitals[A]: 1,645; 
Number (percentage) awarded a Medicare EHR incentive payment: 851 
(51.7%); 
Relative risk ratio[B]: 1.1. 

Characteristics: Chain membership; 
Categories: Nonchain; 
2011: 
Number of eligible hospitals[A]: 3,018; 
Number (percentage) awarded a Medicare EHR incentive payment: 454 
(15.0%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible hospitals[A]: 3,018; 
Number (percentage) awarded a Medicare EHR incentive payment: 1,419 
(47.0%); 
Relative risk ratio[B]: [Empty]. 

Source: GAO analysis of CMS data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. We compared the characteristics of the 
hospitals that were awarded a Medicare EHR incentive payment for 2012 
and for 2011 to those of other eligible hospitals that were not 
awarded a payment in the same year. The sum of the number of hospitals 
listed by category may not equal the overall number of hospitals due 
to missing data. 

[A] We use the term eligible hospitals to refer to those hospitals 
that were eligible for the Medicare EHR program, regardless of whether 
they were awarded a Medicare EHR incentive payment for 2011 and 2012. 
Specifically, eligible hospitals are those that were (1) acute care 
hospitals or critical access hospitals; (2) located in one of the 50 
states or the District of Columbia; (3) were not terminated from 
participating in the Medicare program before October 1, 2010, for 
determining eligibility for 2011; or on or before October 1, 2011, for 
determining eligibility for 2012; and (4) were not awarded an 
incentive payment from the Medicare Advantage Organization (MAO) EHR 
program during the same year. 

[B] The relative risk ratios indicate how much more likely a hospital 
in each category was to have been awarded an EHR incentive payment 
than a hospital in the category that was least likely to have been 
awarded a payment, which is labeled [Empty]. A relative risk ratio of 
1.0 indicates no difference in the likelihood of having been awarded 
an incentive payment between the two categories, and, as relative risk 
ratios approach 1.0, there is less and less difference in the 
likelihood of having been awarded an incentive payment between the two 
categories. 

[C] Acute care hospitals are hospitals described in Section 1886(d) of 
the Social Security Act, which are paid under the inpatient 
prospective payment system. 

[D] Critical access hospitals typically are very small (25 inpatient 
beds or fewer) and operate in rural areas. 

[End of table] 

Table 6 shows the extent to which the size of hospitals, measured in 
various ways, is related to whether hospitals were awarded Medicare 
EHR incentive payments for 2012. We found that large hospitals were 
generally more likely to have been awarded a Medicare EHR incentive 
payment for 2012 than either small or medium-sized hospitals. 

* Hospitals in the high and middle categories for number of total beds 
for 2012 were 2 and 1.8 times more likely, respectively, than 
hospitals in the low category to have been awarded an incentive 
payment. 

* Hospitals in the high and middle categories for number of total 
discharges for 2012 were 1.9 and 1.6 times more likely, respectively, 
than hospitals in the low category to have been awarded an incentive 
payment. 

For 2011, the relationship between hospital size and having been 
awarded an incentive payment was similar, but the magnitude of the 
differences was not as great. Thus large hospitals were even more 
likely to receive Medicare EHR incentive payments than small hospitals 
for 2012 than for 2011. 

Table 6: Number and Percentage of Hospitals That Were Awarded Medicare 
EHR Incentive Payments for 2011 and 2012, by Hospital Size: 

Characteristics: Overall; 
2011: 
Number of eligible hospitals[A]: 4,825; 
Number (percentage) awarded a Medicare EHR incentive payment: 777 
(16.1%); 
Relative risk ratio[B]: N/A; 
2012: 
Number of eligible hospitals[A]: 4,806; 
Number (percentage) awarded a Medicare EHR incentive payment: 2,291 
(47.7%); 
Relative risk ratio[B]: N/A. 

Characteristics: Total beds[C]; 
Categories: Low; 
2011: 
Number of eligible hospitals[A]: 1,608; 
Number (percentage) awarded a Medicare EHR incentive payment: 185 
(11.5%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible hospitals[A]: 1,606; 
Number (percentage) awarded a Medicare EHR incentive payment: 486 
(30.3%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Total beds[C]; 
Categories: Middle; 
2011: 
Number of eligible hospitals[A]: 1,609; 
Number (percentage) awarded a Medicare EHR incentive payment: 265 
(16.5%); 
Relative risk ratio[B]: 1.4; 
2012: 
Number of eligible hospitals[A]: 1,552; 
Number (percentage) awarded a Medicare EHR incentive payment: 827 
(53.3%); 
Relative risk ratio[B]: 1.8. 

Characteristics: Total beds[C]; 
Categories: High; 
2011: 
Number of eligible hospitals[A]: 1,608; 
Number (percentage) awarded a Medicare EHR incentive payment: 327 
(20.3%); 
Relative risk ratio[B]: 1.8; 
2012: 
Number of eligible hospitals[A]: 1,602; 
Number (percentage) awarded a Medicare EHR incentive payment: 951 
(59.4%); 
Relative risk ratio[B]: 2.0. 

Characteristics: Medicare inpatient bed days[D]; 
Categories: Low; 
2011: 
Number of eligible hospitals[A]: 1,574; 
Number (percentage) awarded a Medicare EHR incentive payment: 194 
(12.3%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible hospitals[A]: 1,568; 
Number (percentage) awarded a Medicare EHR incentive payment: 502 
(32.0%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Medicare inpatient bed days[D]; 
Categories: Middle; 
2011: 
Number of eligible hospitals[A]: 1,572; 
Number (percentage) awarded a Medicare EHR incentive payment: 255 
(16.2%); 
Relative risk ratio[B]: 1.3; 
2012: 
Number of eligible hospitals[A]: 1,567; 
Number (percentage) awarded a Medicare EHR incentive payment: 815 
(52.0%); 
Relative risk ratio[B]: 1.6. 

Characteristics: Medicare inpatient bed days[D]; 
Categories: High; 
2011: 
Number of eligible hospitals[A]: 1,574; 
Number (percentage) awarded a Medicare EHR incentive payment: 324 
(20.6%); 
Relative risk ratio[B]: 1.7; 
2012: 
Number of eligible hospitals[A]: 1,568; 
Number (percentage) awarded a Medicare EHR incentive payment: 953 
(60.8%); 
Relative risk ratio[B]: 1.9. 

Characteristics: Total discharges[E]; 
Categories: Low; 
2011: 
Number of eligible hospitals[A]: 1,576; 
Number (percentage) awarded a Medicare EHR incentive payment: 195 
(12.4%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible hospitals[A]: 1,570; 
Number (percentage) awarded a Medicare EHR incentive payment: 506 
(32.2%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Total discharges[E]; 
Categories: Middle; 
2011: 
Number of eligible hospitals[A]: 1,577; 
Number (percentage) awarded a Medicare EHR incentive payment: 248 
(15.7%); 
Relative risk ratio[B]: 1.3; 
2012: 
Number of eligible hospitals[A]: 1,570; 
Number (percentage) awarded a Medicare EHR incentive payment: 805 
(51.3%); 
Relative risk ratio[B]: 1.6. 

Characteristics: Total discharges[E]; 
Categories: High; 
2011: 
Number of eligible hospitals[A]: 1,575; 
Number (percentage) awarded a Medicare EHR incentive payment: 331 
(21.0%); 
Relative risk ratio[B]: 1.7; 
2012: 
Number of eligible hospitals[A]: 1,568; 
Number (percentage) awarded a Medicare EHR incentive payment: 959 
(61.2%); 
Relative risk ratio[B]: 1.9. 

Source: GAO analysis of CMS data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. We compared the characteristics of the 
hospitals that were awarded a Medicare EHR incentive payment for 2012 
and for 2011 to those of other eligible hospitals that were not 
awarded a payment in the same year. The sum of the number of hospitals 
listed by category may not equal the overall number of hospitals due 
to missing data. 

[A] We use the term eligible hospitals to refer to those hospitals 
that were eligible for the Medicare EHR program, regardless of whether 
they were awarded a Medicare EHR incentive payment for 2011 and 2012. 
Specifically, eligible hospitals are those that were (1) acute care 
hospitals or critical access hospitals; (2) located in one of the 50 
states or the District of Columbia; (3) were not terminated from 
participating in the Medicare program before October 1, 2010, for 
determining eligibility for 2011; or on or before October 1, 2011, for 
determining eligibility for 2012; and (4) were not awarded an 
incentive payment from the Medicare Advantage Organization (MAO) EHR 
program during the same year. 

[B] The relative risk ratios indicate how much more likely a hospital 
in each category was to have been awarded an EHR incentive payment 
than a hospital in the category that was least likely to have been 
awarded a payment, which is labeled [Empty]. A relative risk ratio of 
1.0 indicates no difference in the likelihood of having been awarded 
an incentive payment between the two categories, and, as relative risk 
ratios approach 1.0, there is less and less difference in the 
likelihood of having been awarded an incentive payment between the two 
categories. 

[C] For total beds, the ranges were as follows: for 2011, low--less 
than or equal to 38; middle--greater than 38 but less than or equal to 
173; and high--greater than 173; and for 2012, low--less than or equal 
to 39; middle--greater than 39 but less than or equal to 174; and 
high--greater than 174. 

[D] For Medicare inpatient bed days, the ranges were as follows: for 
2011, low--less than or equal to 3,611; middle--greater than 3,611 but 
less than or equal to 26,353; and high--greater than 26,353; and for 
2012, low--less than or equal to 3,493; middle--greater than 3,493 but 
less than or equal to 25,915; and high--greater than 25,915. 

[E] For total discharges, the ranges were as follows: for 2011, low--
less than or equal to 1,091; middle--greater than 1,091 but less than 
or equal to 6,586; and high--greater than 6,586; and for 2012, low--
less than or equal to 1,072; middle--greater than 1,072 but less than 
or equal to 6,471; and high--greater than 6,471. 

[End of table] 

Table 7 shows the relationship between receiving Medicare EHR 
incentive payments for 2012 and the amounts of total charges and of 
charity charges. We found the following: 

* The amount of total charges had an effect on the likelihood that 
hospitals were awarded an EHR incentive payment for 2012. For example, 
for 2012, hospitals in the middle and high categories for total 
charges were 1.4 and 1.8 times more likely, respectively, to have been 
awarded an incentive payment than hospitals in the low category. 

* Hospitals in the high category for charity charges were more likely 
to receive a Medicare EHR incentive payment for 2012 compared to 
hospitals in the low category. Specifically, for 2012, hospitals in 
the middle or high categories were 1.3 and 1.6 times more likely, 
respectively, to have been awarded an incentive payment than hospitals 
in the low category. 

For 2011 the relationship between charity charges and whether 
hospitals were awarded Medicare EHR incentive payments was similar. 
However, the relationship between total charges and receiving a 
Medicare EHR incentive payment was different for 2011. Specifically, 
for 2011, hospitals in the high category for total charges were more 
likely to receive a payment than hospitals in either the middle or the 
low categories. In contrast, for 2012, the high and middle categories 
had a greater likelihood of receiving a payment compared to the low 
category. 

Table 7: Number and Percentage of Hospitals That Were Awarded Medicare 
EHR Incentive Payments for 2011 and 2012, by Hospital Charges: 

Characteristics: Overall; 
2011: 
Number of eligible hospitals[A]: 4,825; 
Number (percentage) awarded a Medicare EHR incentive payment: 777 
(16.1%); 
Relative risk ratio[B]: N/A; 
2012: 
Number of eligible hospitals[A]: 4,806; 
Number (percentage) awarded a Medicare EHR incentive payment: 2,291 
(47.7%); 
Relative risk ratio[B]: N/A. 

Characteristics: Total charges[C]; 
Categories: Low; 
2011: 
Number of eligible hospitals[A]: 1,576; 
Number (percentage) awarded a Medicare EHR incentive payment: 216 
(13.7%); 
Relative risk ratio[B]: 1.0; 
2012: 
Number of eligible hospitals[A]: 1,570; 
Number (percentage) awarded a Medicare EHR incentive payment: 539 
(34.3%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Total charges[C]; 
Categories: Middle; 
2011: 
Number of eligible hospitals[A]: 1,580; 
Number (percentage) awarded a Medicare EHR incentive payment: 212 
(13.5%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible hospitals[A]: 1,574; 
Number (percentage) awarded a Medicare EHR incentive payment: 761 
(48.3%); 
Relative risk ratio[B]: 1.4. 

Characteristics: Total charges[C]; 
Categories: High; 
2011: 
Number of eligible hospitals[A]: ,576; 
Number (percentage) awarded a Medicare EHR incentive payment: 344 
(21.8%); 
Relative risk ratio[B]: 1.6; 
2012: 
Number of eligible hospitals[A]: 1,570; 
Number (percentage) awarded a Medicare EHR incentive payment: 970 
(61.8%); 
Relative risk ratio[B]: 1.8. 

Characteristics: Charity charges[D]; 
Categories: Low; 
2011: 
Number of eligible hospitals[A]: 1,400; 
Number (percentage) awarded a Medicare EHR incentive payment: 204 
(14.6%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible hospitals[A]: 1,420; 
Number (percentage) awarded a Medicare EHR incentive payment: 545 
(38.4%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Charity charges[D]; 
Categories: Middle; 
2011: 
Number of eligible hospitals[A]: 1,403; 
Number (percentage) awarded a Medicare EHR incentive payment: 235 
(16.7%); 
Relative risk ratio[B]: 1.1; 
2012: 
Number of eligible hospitals[A]: 1,422; 
Number (percentage) awarded a Medicare EHR incentive payment: 722 
(50.8%); 
Relative risk ratio[B]: 1.3. 

Characteristics: Charity charges[D]; 
Categories: High; 
2011: 
Number of eligible hospitals[A]: 1,400; 
Number (percentage) awarded a Medicare EHR incentive payment: 297 
(21.2%); 
Relative risk ratio[B]: 1.5; 
2012: 
Number of eligible hospitals[A]: 1,420; 
Number (percentage) awarded a Medicare EHR incentive payment: 861 
(60.6%); 
Relative risk ratio[B]: 1.6. 

Characteristics: Charity charges[D]; 
Categories: Missing[E]; 
2011: 
Number of eligible hospitals[A]: 622; 
Number (percentage) awarded a Medicare EHR incentive payment: 41 
(6.6%); 
Relative risk ratio[B]: N/A; 
2012: Number of eligible hospitals[A]: 544; 
2012: Number (percentage) awarded a Medicare EHR incentive payment: 
163 (30.0%); 
2012: Relative risk ratio[B]: Relative risk ratio[B]: N/A. 

Source: GAO analysis of CMS data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. We compared the characteristics of the 
hospitals that were awarded a Medicare EHR incentive payment for 2012 
and for 2011 to those of other eligible hospitals that were not 
awarded a payment in the same year. The sum of the number of hospitals 
listed by category may not equal the overall number of hospitals due 
to missing data. 

[A] We use the term eligible hospitals to refer to those hospitals 
that were eligible for the Medicare EHR program, regardless of whether 
they were awarded a Medicare EHR incentive payment for 2011 and 2012. 
Specifically, eligible hospitals are those that were (1) acute care 
hospitals or critical access hospitals; (2) located in one of the 50 
states or the District of Columbia; (3) were not terminated from 
participating in the Medicare program before October 1, 2010, for 
determining eligibility for 2011; or on or before October 1, 2011, for 
determining eligibility for 2012; and (4) were not awarded an 
incentive payment from the Medicare Advantage Organization (MAO) EHR 
program during the same year. 

[B] The relative risk ratios indicate how much more likely a hospital 
in each category was to have been awarded an EHR incentive payment 
than a hospital in the category that was least likely to have been 
awarded a payment, which is labeled [Empty]. A relative risk ratio of 
1.0 indicates no difference in the likelihood of having been awarded 
an incentive payment between the two categories, and, as relative risk 
ratios approach 1.0, there is less and less difference in the 
likelihood of having been awarded an incentive payment between the two 
categories. 

[C] For total charges, the ranges were as follows: for 2011, low--less 
than or equal to $61,333,788; middle--greater than $61,333,788 but 
less than or equal to $375,676,705; and high--greater than 
$375,676,705; and for 2012, low--less than or equal to $63,732,912; 
middle--greater than $63,732,912 but less than or equal to 
$388,812,277; and high--greater than $388,812,277. 

[D] Charity charges reflect the cost for providing inpatient and 
outpatient hospital services for which the hospital is not 
compensated. For charity charges, the ranges were as follows: for 
2011, low--less than or equal to $1,044,578; middle--greater than 
$1,044,578 but less than or equal to $8,861,923; and high--greater 
than $8,861,923; and for 2012, low--less than or equal to $1,052,181; 
middle--greater than $1,052,181 but less than or equal to $9,222,248; 
and high--greater than $9,222,248. 

[E] Information on charity charges was missing for 622 eligible 
hospitals (13 percent) for 2011 and for 544 eligible hospitals (11 
percent) for 2012. 

[End of table] 

Table 8 compares the likelihood of hospitals with specific 
characteristics having been awarded Medicare EHR incentive payments 
for 2012 compared to 2011. For this analysis, in contrast to that for 
tables 4 through 7, we calculated relative risk ratios that indicate 
how much more likely a hospital in a given category for 2012 was to 
have been awarded an EHR incentive payment than a hospital in the same 
category for 2011. For example, as table 8 shows, under the 
characteristic "geographic region," the relative risk ratio of 3.8 for 
the category "Northeast" indicates that hospitals in the Northeast for 
2012 were 3.8 times more likely to have been awarded an incentive 
payment than hospitals in the Northeast for 2011. A relative risk 
ratio of 1.0 would indicate that there was no difference between 2012 
and 2011 in the likelihood of hospitals in that category having been 
awarded an incentive payment. 

Overall, hospitals for 2012 were 3.0 times more likely to receive an 
incentive payment than hospitals for 2011. Therefore, for each 
category, a relative risk ratio greater than 3.0 indicates a greater 
increase than for hospitals overall in the likelihood of having been 
awarded an incentive payment for 2012 compared to 2011. 

In examining the relationships presented in table 8, we found the 
following: 

* The likelihood of hospitals having been awarded an incentive payment 
for 2012 compared to 2011 increased more in the Northeast and West 
than in the Midwest and South. 

* Hospitals in rural areas were 3.1 times more likely to have been 
awarded an incentive payment for 2012 compared to 2011, which was a 
slightly greater increase than for hospitals overall. 

* Critical access hospitals were 2.6 times more likely to have been 
awarded an incentive payment for 2012 compared to 2011, a moderately 
smaller increase than for hospitals overall. 

Table 8: The Likelihood of Hospitals Being Awarded Medicare EHR 
Incentive Payments for 2012 Compared to 2011, by Characteristic: 

Overall: 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 777 (16.1%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 2,291 (47.7%); 
Relative risk ratio[A]: 3.0. 

Geographic region: Midwest; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 241 (16.5%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 689 (47.4%); 
Relative risk ratio[A]: 2.9. 

Geographic region: Northeast; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 92 (15.2%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 353 (58.1%); 
Relative risk ratio[A]: 3.8. 

Geographic region: South; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 353 (18.9%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 900 (48.4%); 
Relative risk ratio[A]: 2.6. 

Geographic region: West; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 91 (10.2%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 349 (39.4%); 
Relative risk ratio[A]: 3.9. 

Location: Rural; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 282 (13.6%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 882 (42.7%); 
Relative risk ratio[A]: 3.1. 

Location: Urban; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 491 (18.0%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 1,393 (51.3%); 
Relative risk ratio[A]: 2.8. 

Hospital classification: Acute care hospital[B]; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 626 (17.9%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 1,905 (54.9%); 
Relative risk ratio[A]: 3.1. 

Hospital classification: Critical access hospital[C]; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 151 (11.3%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 386 (28.9%); 
Relative risk ratio[A]: 2.6. 

Ownership type: For-profit; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 174 (20.7%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 415 (49.1%); 
Relative risk ratio[A]: 2.4. 

Ownership type: Government-owned; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 187 (15.3%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 507 (42.9%); 
Relative risk ratio[A]: 2.8. 

Ownership type: Nonprofit; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 416 (15.2%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 1,367 (49.5%); 
Relative risk ratio[A]: 3.3. 

Chain membership: Chain; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 313 (20.2%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 851 (51.7%); 
Relative risk ratio[A]: 2.6. 

Chain membership: Nonchain; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 454 (15.0%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 1,419 (47.0%); 
Relative risk ratio[A]: 3.1. 

Total beds[D]: Low; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 185 (11.5%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 486 (30.3%); 
Relative risk ratio[A]: 2.6. 

Total beds[D]: Middle; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 265 (16.5%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 827 (53.3%); 
Relative risk ratio[A]: 3.2. 

Total beds[D]: High; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 327 (20.3%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 951 (59.4%); 
Relative risk ratio[A]: 2.9. 

Source: GAO analysis of CMS, Office of the National Coordinator for 
Health Information Technology, and Health Resources and Services 
Administration data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. We compared the characteristics of the 
hospitals that were awarded a Medicare EHR incentive payment for 2012 
and for 2011 to those of other eligible hospitals that were not 
awarded a payment in the same year. The sum of the number of hospitals 
listed by category may not equal the overall number of hospitals due 
to missing data. 

[A] The relative risk ratios indicate how much more likely a hospital 
in a given category was to have been awarded an EHR incentive payment 
for 2012 than a hospital in the same category was to have been awarded 
an EHR incentive payment for 2011. A relative risk ratio of 1.0 would 
indicate that there was no difference in the likelihood of hospitals 
in that category having been awarded an incentive payment for 2012 
compared to 2011. 

[B] Acute care hospitals are hospitals described in Section 1886(d) of 
the Social Security Act, which are paid under the inpatient 
prospective payment system. 

[C] Critical access hospitals typically are very small (25 inpatient 
beds or fewer) and operate in rural areas. 

[D] For total beds, the ranges were as follows: for 2011, low--less 
than or equal to 38; middle--greater than 38 but less than or equal to 
173; and high--greater than 173; and for 2012, low--less than or equal 
to 39; middle--greater than 39 but less than or equal to 174; and 
high--greater than 174. 

[End of table] 

[End of section] 

Enclosure III: Information on Professionals Who Were Awarded Medicare: 

EHR Incentive Payments for 2012 and 2011: 

This enclosure provides information on the amount of Medicare EHR 
incentive payments awarded to professionals for 2012, the number and 
percentage of professionals who were awarded incentive payments, and 
the characteristics of professionals who were awarded incentive 
payments. This enclosure also compares different categories of 
eligible professionals to determine which were more likely and which 
were less likely for 2012 to have been awarded an incentive payment. 
In some cases, information on Medicare EHR incentive payments awarded 
to professionals for 2011 is presented for comparison. In addition, 
this enclosure compares the characteristics of professionals awarded 
incentive payments for 2012 to the characteristics of professionals 
awarded incentive payments for 2011. 

Of the estimated 588,156 eligible professionals, 31 percent or 183,712 
professionals were awarded a Medicare EHR incentive payment for 2012. 
The percentage of eligible professionals who were awarded a Medicare 
EHR incentive payment varied by state for 2012. In contrast to 
hospitals, for which there were 18 states where 50 percent or more of 
eligible hospitals were awarded Medicare EHR incentive payments, for 
professionals there were no states with percentages over 50. Among 
states, South Dakota awarded Medicare EHR incentive payments to the 
greatest percentage of eligible professionals for 2012 at 47 percent, 
whereas 14 percent of eligible professionals in Alaska were awarded an 
incentive payment for 2012 (see figure 6). 

Figure 6: Percentage of Eligible Professionals Who Were Awarded a 
Medicare EHR Incentive Payment for 2012 Alone and for Both 2011 and 
2012, by State: 

[Refer to PDF for image: stacked horizontal bar graph] 

The nationwide average percentage of professionals awarded an 
incentive payment for 2012: 31%. 

State: South Dakota; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 38%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 9.3%. 

State: Minnesota; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 34%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 12%. 

State: Wisconsin; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 35%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 10%. 

State: Massachusetts; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 30%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 14%. 

State: New Hampshire; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 23%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 21%. 

State: Iowa; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 30%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 10%. 

State: Delaware; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 27%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 13%. 

State: Oregon; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 26%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 13%. 

State: North Dakota; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 33%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 5.8%. 

State: Virginia; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 27%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 11%. 

State: North Carolina; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 30%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 7.5%. 

State: Missouri; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 27%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 9.8%. 

State: Kansas; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 28%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 7.8%. 

State: Utah; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 29%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 6.4%. 

State: Ohio; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 24%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 11%. 

State: Pennsylvania; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 25%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 9.8%. 

State: Nebraska; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 26%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 8.4%. 

State: Indiana; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 28%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 6.3%. 

State: Illinois; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 23%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 11%. 

State: Alabama; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 26%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 6.8%. 

State: Colorado; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 24%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 7.9%. 

State: Florida; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 24%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 7.1%. 

State: Idaho; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 26%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 4.2%. 

State: West Virginia; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 20%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 10%. 

State: South Carolina; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 26%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 3.9%. 

State: Michigan; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 24%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 5.9%. 

State: Arkansas; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 23%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 6.9%. 

State: Washington; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 21%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 8.9%. 

State: New Jersey; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 22%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 7.6%. 

State: Connecticut; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 23%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 6.3%. 

State: Tennessee; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 22%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 7%. 

Hawaii; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 20%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 8.4%. 

Georgia; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 22%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 6.3%. 

Louisiana; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 24%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 4.2%. 

Texas; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 21%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 7.2%. 

Mississippi; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 21%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 6.9%. 

Montana; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 22%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 5.6%. 

Vermont; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 24%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 3.2%. 

Oklahoma; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 19%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 7.9%. 

Nevada; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 20%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 6.6%. 

Maine; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 18%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 8.5%. 

Arizona; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 20%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 6.3%. 

California; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 20%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 5.8%. 

Kentucky; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 19%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 6.8%. 

Maryland; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 20%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 5.7%. 

Wyoming; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 20%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 4.9%. 

New Mexico; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 22%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 2.6%. 

New York; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 17%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 6.1%. 

Rhode Island; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 13%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 9.1%. 

District of Columbia; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 19%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 2%. 

Alaska; 
Percentage of eligible professionals awarded an incentive payment for 
2012 alone: 12%; 
Percentage of eligible professionals awarded an incentive payment for 
2011 and 2012: 1.8%. 

Source: GAO analysis of CMS data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. This figure illustrates the percentage 
of eligible professionals who were awarded Medicare EHR incentive 
payments for 2012 by state, as indicated in the full length of each 
bar. These bars are divided to indicate the percentage of eligible 
professionals who were awarded an incentive payment only for 2012, 
designated by the darker shading, and the percentage of eligible 
professionals who were awarded an incentive payment for both 2011 and 
2012, designated by the lighter shading. This figure excludes the 
5,364 eligible professionals for 2011 (49 of which were awarded a 
Medicare EHR incentive payment) and the 5,093 eligible professionals 
for 2012 (259 of which were awarded a Medicare EHR incentive payment) 
who practiced in U.S. insular areas. 

[End of figure] 

Nationwide, most of the professionals (75 percent) who were awarded a 
Medicare EHR incentive payment for 2012 were new to the program--that 
is, they did not receive a payment for 2011--with substantial 
variation among states. These professionals make up 23 percent of 
eligible professionals nationwide. South Dakota had the largest 
percentage (38 percent) of eligible professionals who were new to the 
program for 2012, meaning they did not receive a payment for 2011. 
Additionally, almost all professionals who received Medicare EHR 
incentive payments for 2012 in the District of Columbia were new to 
the Medicare EHR incentive program for 2012. In contrast, 
approximately half of the professionals in New Hampshire who received 
incentive payments for 2012 were new to the program. While many 
professionals were new to the program for 2012, 20 percent of 
professionals awarded a Medicare EHR incentive payment for 2011 were 
not awarded a payment for 2012. 

Of the $6.3 billion in Medicare EHR incentive payments that were 
awarded to providers for 2012, $2.8 billion was awarded to 
professionals. Among participating professionals, 63 percent were 
awarded an incentive payment of $18,000, indicating these 
professionals first participated for 2012 and earned the maximum 
incentive payment amount. Twenty-seven percent were awarded an 
incentive payment of $12,000 to less than $18,000--85 percent of these 
professionals were first awarded incentives for 2011 and 15 percent 
were first awarded incentives for 2012 but earned less than the 
maximum incentive amount. Ten percent of professionals were awarded an 
incentive payment of less than $12,000. (See figure 7.) 

Figure 7: Percentage of Professionals Who Were Awarded Medicare EHR 
Incentive Payments for 2012, by Amount: 

[Refer to PDF for image: pie-chart] 

2012: 
$18,000: 63%; 
Greater than or equal to $120,000 but less than $18,000: 27%; 
Less than $12,000: 10%. 

Source: GAO analysis of CMS data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. The figure does not include the 10 
percent additional payments for professionals who practice 
predominately in a health professional shortage area because CMS had 
not disbursed those payments as of the date of our analysis. 
Therefore, the maximum payment amount professionals received for 2012 
is $18,000. 

[End of figure] 

The characteristics among professionals who were awarded a Medicare 
EHR incentive payment for 2012 are similar to those among 
professionals awarded a Medicare EHR incentive payment for 2011 (see 
figure 8). Specifically, for 2012, 

* the largest proportion (32 percent) was in the South, and the 
smallest proportion (18 percent) was in the West; 

* a significant majority (90 percent) was in urban areas; 

* over half (56 percent) were specialty practice physicians, and over 
one-third (34 percent) were general practice physicians; 

* about half (46 percent) had relatively high amounts of 2012 Medicare 
Part B charges. 

Figure 8: Selected Characteristics of Professionals Who Were Awarded a 
Medicare EHR Incentive Payment for 2011 and 2012: 

[Refer to PDF for image: 4 vertical bar graphs] 

Region: 

Northeast; 
2011: 24.1%; 
2012: 21.7%. 

South; 
2011: 31.2%; 
2012: 32.4%. 

Midwest; 
2011: 27.5%; 
2012: 28.2%. 

West; 
2011: 17.1%; 
2012: 17.6%. 

Location: 

Rural; 
2011: 10.9%; 
2012: 10.5%. 

Urban; 
2011: 89.1%; 
2012: 89.5%. 

Specialty: 

Chiropractor; 
2011: 2.5%; 
2012: 2.6%. 

General|Practice; 
2011: 37.9%; 
2012: 33.9%. 

Optometrist; 
2011: 4.3%; 
2012: 4.4%. 

Podiatrist; 
2011: 5%; 
2012: 3.4%. 

Specialist; 
2011: 50.2%; 
2012: 55.7%. 

Medicare Part B charges: 

Low; 
2011: 16.7%; 
2012: 18%. 

Medium; 
2011: 37%; 
2012: 35.4%. 

High; 
2011: 45.9%; 
2012: 44.4%. 

Source: GAO analysis of CMS and Health Resources and Services 
Administration data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. For a given year, the sum of the 
percentage of professionals listed for a given characteristic may not 
equal 100 percent due to missing data or rounding. For specialty, we 
did not include dentists because the percentages of dentists who were 
awarded a Medicare EHR incentive payment for 2011 and 2012 rounded to 
zero. This figure for region excludes the 5,364 eligible professionals 
for 2011 (49 of which were awarded a Medicare EHR incentive payment) 
and the 5,093 eligible professionals for 2012 (259 of which were 
awarded a Medicare EHR incentive payment) who practiced in U.S. 
insular areas. For Medicare Part B charges, the ranges were as 
follows: for 2011, low--less than or equal to $29,747; middle--greater 
than $29,747 but less than or equal to $134,601; and high--greater 
than $134,601; and for 2012, low--less than or equal to $49,269; 
middle--greater than $49,269 but less than or equal to $218,365; and 
high--greater than $218,365. 

[End of figure] 

Specialists make up the largest proportion of professionals who were 
awarded a Medicare EHR incentive payment for 2012. However, a little 
less than one third (29 percent) of eligible specialty practice 
physicians were awarded a Medicare EHR incentive payment for 2012, and 
the percentage varied substantially by specialty. For example, 54 
percent of gastroenterologists were awarded a Medicare EHR incentive 
payment, compared to 7 percent of psychiatrists. (See figure 9.) 

Figure 9: Percentage of Specialty Practice Physicians Who Were Awarded 
a Medicare EHR Incentive Payment for 2012, by Selected Specialty: 

[Refer to PDF for image: stacked horizontal bar graph] 

Specialty: Gastroenterology; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 54.3%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 45.7%. 

Specialty: Nephrology; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 52.3%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 47.7%. 

Specialty: Urology; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 51%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 49%. 

Specialty: Cardiology; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 50.6%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 49.4%. 

Specialty: Pulmonary Disease; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 50.6%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 49.4%. 

Specialty: Endocrinology; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 50.3%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 49.7%. 

Specialty: Oncology; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 46.6%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 53.4%. 

Specialty: Otolaryngology; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 44.5%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 55.5%. 

Specialty: Neurology; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 41.2%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 58.8%. 

Specialty: Surgery; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 37.1%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 62.9%. 

Specialty: Ophthalmology; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 31.7%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 68.3%. 

Specialty: Dermatology; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 31%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 69%. 

Specialty: Physical Medicine; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 28.6%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 71.4%. 

Specialty: Obstetrics/Gynecology; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 28.7%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 71.3%. 

Specialty: Radiologist; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 12%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 88%. 

Specialty: Psychiatry; 
Percentage of eligible professionals awarded an incentive payment in 
2012: 7.1%; 
Percentage of eligible professionals not awarded an incentive payment 
in 2012: 92.9%. 

Source: GAO analysis of CMS data. 

Note: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. 

[End of figure] 

Tables 9 through 11 compare the characteristics of professionals who 
were awarded Medicare EHR incentive payments for 2012 and 2011 to 
those of other eligible Medicare professionals who did not receive a 
payment for those years. Each characteristic is divided into two or 
more categories. For example, the characteristic "geographic region" 
is divided into four categories--Midwest, Northeast, South, and West. 
As part of this analysis, we calculated relative risk ratios that 
indicate how much more likely a professional in each category was to 
have been awarded an EHR incentive payment in a given year than a 
professional in the category that was least likely to have been 
awarded a payment for the same year. The categories in which 
professionals were least likely to receive an incentive payment are 
labeled [Empty]. For example, as table 9 shows, under the 
characteristic "geographic region" for 2012, the relative risk ratio 
of 1.3 for the category "Midwest" indicates that, for 2012, 
professionals in the Midwest were 1.3 times more likely to have been 
awarded an incentive payment than professionals in the West, who were 
the least likely to receive an incentive payment. A relative risk 
ratio of 1.0 indicates no difference in the likelihood of having been 
awarded an incentive payment between the two categories for the given 
year, and, as relative risk ratios approach 1.0, there is less and 
less difference in the likelihood of having been awarded an incentive 
payment between the two categories. 

Table 9 shows the relationship between professionals receiving 
Medicare EHR incentive payments for 2012 and the regions in which the 
professionals are practicing. We found that geographic location had a 
modest effect on the likelihood that professionals were awarded an EHR 
incentive payment for 2012. For example, 

* professionals practicing in the Midwest--the region with the highest 
percentage of professionals awarded an incentive payment for 2012--
were 1.3 times more likely to have been awarded a payment than 
professionals in the West--the region with the lowest percentage of 
professionals awarded an incentive payment in the same year; 

* professionals practicing in health professional shortage areas were 
1.3 times less likely to have been awarded a payment than other 
professionals; and: 

* in contrast, professionals practicing in urban areas were no more 
likely to have been awarded an incentive payment than rural 
professionals. 

The relationship between geographic location and receiving a Medicare 
EHR incentive payment was generally similar for 2011 compared to for 
2012. 

Table 9: Number and Percentage of Professionals Who Were Awarded 
Medicare EHR Incentive Payments for 2011 and 2012, by Regional 
Characteristics: 

Characteristics: Overall; 
2011: 
Number of eligible professionals[A]: 573,551; 
Number (percentage) awarded a Medicare EHR incentive payment: 58,331 
(10.2%); 
Relative risk ratio[B]: N/A; 
2012: 
Number of eligible professionals[A]: 588,156; 
Number (percentage) awarded a Medicare EHR incentive payment: 183,712 
(31.2%); 
Relative risk ratio[B]: N/A. 

Characteristics: Geographic region[C]; 
Categories: Midwest; 
2011: 
Number of eligible professionals[A]: 138,134; 
Number (percentage) awarded a Medicare EHR incentive payment: 16,048 
(11.6%); 
Relative risk ratio[B]: 1.3; 
2012: 
Number of eligible professionals[A]: 141,986; 
Number (percentage) awarded a Medicare EHR incentive payment: 51,778 
(36.5%); 
Relative risk ratio[B]: 1.3. 

Characteristics: Geographic region[C]; 
Categories: Northeast; 
2011: 
Number of eligible professionals[A]: 128,204; 
Number (percentage) awarded a Medicare EHR incentive payment: 14,052 
(11.0%); 
Relative risk ratio[B]: 1.2; 
2012: 
Number of eligible professionals[A]: 130,393; 
Number (percentage) awarded a Medicare EHR incentive payment: 39,945 
(30.6%); 
Relative risk ratio[B]: 1.1. 

Characteristics: Geographic region[C]; 
Categories: South; 
2011: 
Number of eligible professionals[A]: 190,443; 
Number (percentage) awarded a Medicare EHR incentive payment: 18,215 
(9.6%); 
Relative risk ratio[B]: 1.1; 
2012: 
Number of eligible professionals[A]: 195,729; 
Number (percentage) awarded a Medicare EHR incentive payment: 59,464 
(30.4%); 
Relative risk ratio[B]: 1.1. 

Characteristics: Geographic region[C]; 
Categories: West; 
2011: 
Number of eligible professionals[A]: 111,401; 
Number (percentage) awarded a Medicare EHR incentive payment: 9,962 
(8.9%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible professionals[A]: 114,946; 
Number (percentage) awarded a Medicare EHR incentive payment: 32,257 
(28.1%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Location; 
Categories: Rural; 
2011: 
Number of eligible professionals[A]: 62,380; 
Number (percentage) awarded a Medicare EHR incentive payment: 6,332 
(10.2%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible professionals[A]: 62,486; 
Number (percentage) awarded a Medicare EHR incentive payment: 19,194 
(30.7%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Location; 
Categories: Urban; 
2011: 
Number of eligible professionals[A]: 510,714; 
Number (percentage) awarded a Medicare EHR incentive payment: 51,968 
(10.2%); 
Relative risk ratio[B]: 1.0; 
2012: 
Number of eligible professionals[A]: 525,392; 
Number (percentage) awarded a Medicare EHR incentive payment: 164,451 
(31.3%); 
Relative risk ratio[B]: 1.0. 

Characteristics: Located in a Health Professional Shortage Area; 
Categories: Yes; 
2011: 
Number of eligible professionals[A]: 18,136; 
Number (percentage) awarded a Medicare EHR incentive payment: 1,372 
(7.6%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible professionals[A]: 14,605; 
Number (percentage) awarded a Medicare EHR incentive payment: 3,467 
(23.7%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Located in a Health Professional Shortage Area; 
Categories: No; 
2011: 
Number of eligible professionals[A]: 554,968; 
Number (percentage) awarded a Medicare EHR incentive payment: 56,930 
(10.3%); 
Relative risk ratio[B]: 1.4; 
2012: 
Number of eligible professionals[A]: 573,295; 
Number (percentage) awarded a Medicare EHR incentive payment: 180,184 
(31.4%); 
Relative risk ratio[B]: 1.3. 

Characteristics: Located in a county with a Beacon Community; 
Categories: Yes; 
2011: 
Number of eligible professionals[A]: 36,848; 
Number (percentage) awarded a Medicare EHR incentive payment: 3,196 
(8.7%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible professionals[A]: 37,299; 
Number (percentage) awarded a Medicare EHR incentive payment: 11,916 
(31.9%); 
Relative risk ratio[B]: 1.0. 

Characteristics: Located in a county with a Beacon Community; 
Categories: No; 
2011: 
Number of eligible professionals[A]: 536,256; 
Number (percentage) awarded a Medicare EHR incentive payment: 55,106 
(10.3%); 
Relative risk ratio[B]: 1.2; 
2012: 
Number of eligible professionals[A]: 550,601; 
Number (percentage) awarded a Medicare EHR incentive payment: 171,735 
(31.2%); 
Relative risk ratio[B]: [Empty]. 

Source: GAO analysis of CMS, Office of the National Coordinator for 
Health Information Technology, and Health Resources and Services 
Administration data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. We compared the characteristics of the 
professionals who were awarded a Medicare EHR incentive payment for 
2012 and for 2011 to those of other eligible professionals who were 
not awarded a payment in the same year. The sum of the number of 
professionals listed by category may not equal the overall number of 
professionals due to missing data. 

[A] We use the term eligible professionals to refer to those 
professionals who were eligible for the Medicare EHR program, 
regardless of whether they were awarded a Medicare EHR incentive 
payment for 2011 and 2012. Specifically, eligible professionals are 
those who (1) were permissible types of providers: doctors of 
medicine, dental medicine or surgery, optometry, osteopathy, and 
podiatric medicine and chiropractors; (2) were not hospital-based; (3) 
had greater than $0 in Medicare Part B charges in calendar year 2010 
or 2011; (4) were not awarded an incentive payment from the Medicare 
Advantage Organization (MAO) EHR program during the same year; and (5) 
were not awarded an incentive payment from the Medicaid EHR program 
during the same year. 

[B] The relative risk ratios indicate how much more likely a 
professional in each category was to have been awarded an EHR 
incentive payment than a professional in the category that was least 
likely to have been awarded a payment, which is labeled "-". A 
relative risk ratio of 1.0 indicates no difference in the likelihood 
of having been awarded an incentive payment between the two 
categories, and, as relative risk ratios approach 1.0, there is less 
and less difference in the likelihood of having been awarded an 
incentive payment between the two categories. 

[C] For 2011, 5,364 eligible professionals practiced in U.S. insular 
areas, which are not included in the four U.S. census regions. Of 
those, 49 (1 percent) were awarded a Medicare EHR incentive payment. 
For 2012, 5,093 eligible professionals practiced in U.S. insular 
areas, and 259 of them (5 percent) were awarded a Medicare EHR 
incentive payment. 

[End of table] 

Table 10 shows the relationship between professional characteristics--
such as specialty, years since the professional's medical degree was 
awarded, and involvement with Regional Extension Centers--and receipt 
of a Medicare EHR incentive payment for 2012. We found that: 

* among general practice physicians and specialty practice physicians--
the two specialty categories that together account for most of the 
eligible professionals--general practice physicians were 1.5 times 
more likely than specialty practice physicians to have been awarded a 
Medicare EHR incentive payment;[Footnote 48] 

* professionals who signed an agreement to receive technical 
assistance from a Regional Extension Center were 1.9 times more likely 
to have been awarded a Medicare EHR incentive payment than 
professionals who did not; and: 

* professionals who were awarded their degrees less than 30 years ago 
were 1.3 times more likely to have been awarded a Medicare EHR 
incentive payment than professionals who were awarded their degrees 30 
or more years ago. 

Compared to specialty practice physicians, general practice physicians 
were even more likely for 2011 to have been awarded an incentive 
payment than they were for 2012.[Footnote 49] Additionally, for 2011 
the effect of having signed an agreement to receive technical 
assistance from a Regional Extension Center was greater than for 2012. 

Table 10: Number and Percentage of Professionals Who Were Awarded 
Medicare EHR Incentive Payments for 2011 and 2012, by Professional 
Characteristics: 

Characteristics: Overall; 
Categories: [Empty]; 
2011: 
Number of eligible professionals[A]: 573,551; 
Number (percentage) awarded a Medicare EHR incentive payment: 58,331 
(10.2%); 
Relative risk ratio[B]: N/A; 
2012: 
Number of eligible professionals[A]: 588,156; 
Number (percentage) awarded a Medicare EHR incentive payment: 183,712 
(31.2%); 
Relative risk ratio[B]: N/A. 

Characteristics: Professional specialty; 
Categories: General practice physician; 
2011: 
Number of eligible professionals[A]: 142,223; 
Number (percentage) awarded a Medicare EHR incentive payment: 22,094 
(15.5%); 
Relative risk ratio[B]: 23.2; 
2012: 
Number of eligible professionals[A]: 146,160; 
Number (percentage) awarded a Medicare EHR incentive payment: 62,285 
(42.6%); 
Relative risk ratio[B]: 28.1. 

Characteristics: Professional specialty; 
Categories: Specialty practice physician; 
2011: 
Number of eligible professionals[A]: 340,914; 
Number (percentage) awarded a Medicare EHR incentive payment: 29,259 
(8.6%); 
Relative risk ratio[B]: 12.8; 
2012: 
Number of eligible professionals[A]: 349,004; 
Number (percentage) awarded a Medicare EHR incentive payment: 102,328 
(29.3%); 
Relative risk ratio[B]: 19.3. 

Characteristics: Professional specialty; 
Categories: Chiropractor; 
2011: 
Number of eligible professionals[A]: 45,076; 
Number (percentage) awarded a Medicare EHR incentive payment: 1,443 
(3.2%); 
Relative risk ratio[B]: 4.8; 
2012: 
Number of eligible professionals[A]: 45,836; 
Number (percentage) awarded a Medicare EHR incentive payment: 4,688 
(10.2%); 
Relative risk ratio[B]: 6.7. 

Characteristics: Professional specialty; 
Categories: Dentist; 
2011: 
Number of eligible professionals[A]: 3,442; 
Number (percentage) awarded a Medicare EHR incentive payment: 23 
(0.7%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible professionals[A]: 3,363; 
Number (percentage) awarded a Medicare EHR incentive payment: 51 
(1.5%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Professional specialty; 
Categories: Optometrist; 
2011: 
Number of eligible professionals[A]: 27,472; 
Number (percentage) awarded a Medicare EHR incentive payment: 2,529 
(9.2%); 
Relative risk ratio[B]: 13.8; 
2012: 
Number of eligible professionals[A]: 28,988; 
Number (percentage) awarded a Medicare EHR incentive payment: 8,119 
(28.0%); 
Relative risk ratio[B]: 18.5. 

Characteristics: Professional specialty; 
Categories: Podiatrist; 
2011: 
Number of eligible professionals[A]: 14,379; 
Number (percentage) awarded a Medicare EHR incentive payment: 2,938 
(20.4%); 
Relative risk ratio[B]: 30.6; 
2012: 
Number of eligible professionals[A]: 14,715; 
Number (percentage) awarded a Medicare EHR incentive payment: 6,151 
(41.8%); 
Relative risk ratio[B]: 27.6. 

Characteristics: Signed an agreement to receive technical assistance 
from a Regional Extension Center; 
Categories: Yes; 
2011: 
Number of eligible professionals[A]: 52,525; 
Number (percentage) awarded a Medicare EHR incentive payment: 12,369 
(23.5%); 
Relative risk ratio[B]: 2.7; 
2012: 
Number of eligible professionals[A]: 67,999; 
Number (percentage) awarded a Medicare EHR incentive payment: 36,843 
(54.2%); 
Relative risk ratio[B]: 1.9. 

Characteristics: Signed an agreement to receive technical assistance 
from a Regional Extension Center; 
Categories: No; 
2011: 
Number of eligible professionals[A]: 521,026; 
Number (percentage) awarded a Medicare EHR incentive payment: 45,962 
(8.8%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible professionals[A]: 520,157; 
Number (percentage) awarded a Medicare EHR incentive payment: 146,869 
(28.2%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Years since degree awarded; 
Categories: Low (15 years or fewer); 
2011: 
Number of eligible professionals[A]: 146,883; 
Number (percentage) awarded a Medicare EHR incentive payment: 16,735 
(11.4%); 
Relative risk ratio[B]: 1.3; 
2012: 
Number of eligible professionals[A]: 167,176; 
Number (percentage) awarded a Medicare EHR incentive payment: 57,829 
(34.6%); 
Relative risk ratio[B]: 1.3. 

Characteristics: Years since degree awarded; 
Categories: Middle (16-29 years); 
2011: 
Number of eligible professionals[A]: 220,184; 
Number (percentage) awarded a Medicare EHR incentive payment: 25,391 
(11.5%); 
Relative risk ratio[B]: 1.3; 
2012: 
Number of eligible professionals[A]: 226,298; 
Number (percentage) awarded a Medicare EHR incentive payment: 77,526 
(34.3%); 
Relative risk ratio[B]: 1.3. 

Characteristics: Years since degree awarded; 
Categories: High (30 years or more); 
2011: 
Number of eligible professionals[A]: 179,408; 
Number (percentage) awarded a Medicare EHR incentive payment: 16,003 
(8.9%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible professionals[A]: 180,069; 
Number (percentage) awarded a Medicare EHR incentive payment: 47,924 
(26.6%); 
Relative risk ratio[B]: [Empty]. 

Source: GAO analysis of CMS and Office of the National Coordinator for 
Health Information Technology data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. We compared the characteristics of the 
professionals who were awarded a Medicare EHR incentive payment for 
2012 and for 2011 to those of other eligible professionals who were 
not awarded a payment in the same year. The sum of the number of 
professionals listed by category may not equal the overall number of 
professionals due to missing data. 

[A] We use the term eligible professionals to refer to those 
professionals who were eligible for the Medicare EHR program, 
regardless of whether they were awarded a Medicare EHR incentive 
payment for 2011 and 2012. Specifically, eligible professionals are 
those who (1) were permissible types of providers: doctors of 
medicine, dental medicine or surgery, optometry, osteopathy, and 
podiatric medicine and chiropractors; (2) were not hospital-based; (3) 
had greater than $0 in Medicare Part B charges in calendar year 2010 
or 2011; (4) were not awarded an incentive payment from the Medicare 
Advantage Organization (MAO) EHR program during the same year; and (5) 
were not awarded an incentive payment from the Medicaid EHR program 
during the same year. 

[B] The relative risk ratios indicate how much more likely a 
professional in each category was to have been awarded an EHR 
incentive payment than a professional in the category that was least 
likely to have been awarded a payment, which is labeled [Empty]. A 
relative risk ratio of 1.0 indicates no difference in the likelihood 
of having been awarded an incentive payment between the two 
categories, and, as relative risk ratios approach 1.0, there is less 
and less difference in the likelihood of having been awarded an 
incentive payment between the two categories. 

[End of table] 

Table 11 shows how much the size of professionals' practices under 
Medicare, measured in various ways, is related to whether 
professionals were awarded Medicare EHR incentive payments for 2012. 
We found that professionals who saw the largest number of Medicare 
patients and billed Medicare the largest amounts were the most likely 
to have been awarded a Medicare EHR incentive payment for 2012. 
Specifically, 

* professionals with the highest total amount of Medicare Part B 
charges were 2.5 times more likely to have been awarded an incentive 
payment than professionals with the lowest amount of Medicare Part B 
charges; and: 

* professionals with the highest number of Medicare Part B encounters 
were 2.6 times more likely to have been awarded an incentive payment 
than professionals with the smallest number of encounters. 

In contrast, the size of practices had a smaller effect on the 
likelihood that professionals were awarded incentive payments for 
2012. For example, practices with 51 or more professionals were 1.4 
times more likely to have been awarded an EHR incentive payment than 
solo practitioners. 

The relationship between receiving a Medicare EHR incentive payment 
and the size of professionals' practices--measured using total amount 
of Medicare Part B charges, total number of Medicare Part B 
encounters, and number of professionals--was generally similar for 
both years; however, the magnitudes of the differences were smaller 
for 2012. 

Table 11: Number and Percentage of Professionals Who Were Awarded 
Medicare EHR Incentive Payments for 2011 and 2012, by Practice Size: 

Characteristics: Overall; 
2011: 
Number of eligible professionals[A]: 573,551; 
Number (percentage) awarded a Medicare EHR incentive payment: 58,331 
(10.2%); 
Relative risk ratio[B]: N/A; 
2012: 
Number of eligible professionals[A]: 588,156; 
Number (percentage) awarded a Medicare EHR incentive payment: 183,712 
(31.2%); 
Relative risk ratio[B]: N/A. 

Characteristics: Total amount of Medicare Part B charges (dollars)[C]; 
Categories: Low; 
2011: 
Number of eligible professionals[A]: 190,527; 
Number (percentage) awarded a Medicare EHR incentive payment: 9,742 
(5.1%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible professionals[A]: 194,249; 
Number (percentage) awarded a Medicare EHR incentive payment: 32,281 
(16.6%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Total amount of Medicare Part B charges (dollars)[C]; 
Categories: Middle; 
2011: 
Number of eligible professionals[A]: 191,098; 
Number (percentage) awarded a Medicare EHR incentive payment: 21,583 
(11.3%); 
Relative risk ratio[B]: 2.2; 
2012: 
Number of eligible professionals[A]: 194,832; 
Number (percentage) awarded a Medicare EHR incentive payment: 64,955 
(33.3%); 
Relative risk ratio[B]: 2.0. 

Characteristics: Total amount of Medicare Part B charges (dollars)[C]; 
Categories: High; 
2011: 
Number of eligible professionals[A]: 190,527; 
Number (percentage) awarded a Medicare EHR incentive payment: 25,607 
(13.4%); 
Relative risk ratio[B]: 2.6; 
2012: 
Number of eligible professionals[A]: 194,249; 
Number (percentage) awarded a Medicare EHR incentive payment: 81,650 
(42.0%); 
Relative risk ratio[B]: 2.5. 

Characteristics: Total number of Medicare Part B encounters[D]; 
Categories: Low; 
2011: 
Number of eligible professionals[A]: 190,636; 
Number (percentage) awarded a Medicare EHR incentive payment: 8,934 
(4.7%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible professionals[A]: 194,422; 
Number (percentage) awarded a Medicare EHR incentive payment: 31,376 
(16.1%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Total number of Medicare Part B encounters[D]; 
Categories: Middle; 
2011: 
Number of eligible professionals[A]: 190,960; 
Number (percentage) awarded a Medicare EHR incentive payment: 19,940 
(10.4%); 
Relative risk ratio[B]: 2.2; 
2012: 
Number of eligible professionals[A]: 194,627; 
Number (percentage) awarded a Medicare EHR incentive payment: 66,550 
(34.2%); 
Relative risk ratio[B]: 2.1. 

Characteristics: Total number of Medicare Part B encounters[D]; 
Categories: High; 
2011: 
Number of eligible professionals[A]: 190,556; 
Number (percentage) awarded a Medicare EHR incentive payment: 28,058 
(14.7%); 
Relative risk ratio[B]: 3.1; 
2012: 
Number of eligible professionals[A]: 194,281; 
Number (percentage) awarded a Medicare EHR incentive payment: 80,960 
(41.7%); 
Relative risk ratio[B]: 2.6. 

Characteristics: Number of professionals in practice; 
Categories: Solo practice; 
2011: 
Number of eligible professionals[A]: 54,148; 
Number (percentage) awarded a Medicare EHR incentive payment: 4,354 
(8.0%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible professionals[A]: 181,140; 
Number (percentage) awarded a Medicare EHR incentive payment: 54,947 
(30.3%); 
Relative risk ratio[B]: [Empty]. 

Characteristics: Number of professionals in practice; 
Categories: 2-10 professionals; 
2011: 
Number of eligible professionals[A]: 99,245; 
Number (percentage) awarded a Medicare EHR incentive payment: 12,535 
(12.6%); 
Relative risk ratio[B]: 1.6; 
2012: 
Number of eligible professionals[A]: 67,704; 
Number (percentage) awarded a Medicare EHR incentive payment: 25,373 
(37.5%); 
Relative risk ratio[B]: 1.2. 

Characteristics: Number of professionals in practice; 
Categories: 11-50 professionals; 
2011: 
Number of eligible professionals[A]: 67,182; 
Number (percentage) awarded a Medicare EHR incentive payment: 7,354 
(10.9%); 
Relative risk ratio[B]: 1.4; 
2012: 
Number of eligible professionals[A]: 38,520; 
Number (percentage) awarded a Medicare EHR incentive payment: 13,946 
(36.2%); 
Relative risk ratio[B]: 1.2. 

Characteristics: Number of professionals in practice; 
Categories: Categories: 51 or more professionals; 
2011: 
Number of eligible professionals[A]: 144,709; 
Number (percentage) awarded a Medicare EHR incentive payment: 18,470 
(12.8%); 
Relative risk ratio[B]: 1.6; 
2012: 
Number of eligible professionals[A]: 70,282; 
2012: 
Number (percentage) awarded a Medicare EHR incentive payment: 30,077 
(42.8%); 
Relative risk ratio[B]: 1.4. 

Characteristics: Number of professionals in practice; 
Categories: More than one group practice of different sizes; 
2011: 
Number of eligible professionals[A]: 122,812; 
Number (percentage) awarded a Medicare EHR incentive payment: 12,202 
(9.9%); 
Relative risk ratio[B]: 1.2; 
2012: 
Number of eligible professionals[A]: 155,333; 
Number (percentage) awarded a Medicare EHR incentive payment: 51,051 
(32.9%); 
Relative risk ratio[B]: 1.1. 

Characteristics: Number of professionals in practice; 
Categories: Missing[E]; 
2011: 
Number of eligible professionals[A]: 85,455; 
Number (percentage) awarded a Medicare EHR incentive payment: 3,416 
(4.0%); 
Relative risk ratio[B]: [Empty]; 
2012: 
Number of eligible professionals[A]: 75,177; 
Number (percentage) awarded a Medicare EHR incentive payment: 8,318 
(11.1%); 
Relative risk ratio[B]: [Empty]. 

Source: GAO analysis of CMS data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. We compared the characteristics of the 
professionals who were awarded a Medicare EHR incentive payment for 
2012 and for 2011 to those of other eligible professionals who were 
not awarded a payment in the same year. The sum of the number of 
professionals listed by category may not equal the overall number of 
professionals due to missing data. 

[A] We use the term eligible professionals to refer to those 
professionals who were eligible for the Medicare EHR program, 
regardless of whether they were awarded a Medicare EHR incentive 
payment for 2011 and 2012. Specifically, eligible professionals are 
those who (1) were permissible types of providers: doctors of 
medicine, dental medicine or surgery, optometry, osteopathy, and 
podiatric medicine and chiropractors; (2) were not hospital-based; (3) 
had greater than $0 in Medicare Part B charges in calendar year 2010 
or 2011; (4) were not awarded an incentive payment from the Medicare 
Advantage Organization (MAO) EHR program during the same year; and (5) 
were not awarded an incentive payment from the Medicaid EHR program 
during the same year. 

[B] The relative risk ratios indicate how much more likely a 
professional in each category was to have been awarded an EHR 
incentive payment than a professional in the category that was least 
likely to have been awarded a payment, which is labeled "-". A 
relative risk ratio of 1.0 indicates no difference in the likelihood 
of having been awarded an incentive payment between the two 
categories, and, as relative risk ratios approach 1.0, there is less 
and less difference in the likelihood of having been awarded an 
incentive payment between the two categories. 

[C] For total amount of Medicare Part B charges, the ranges were as 
follows: for 2011, low--less than or equal to $29,747; middle--greater 
than $29,747 but less than or equal to $134,601; and high--greater 
than $134,601; and for 2012, low--less than or equal to $49,269; 
middle--greater than $49,269 but less than or equal to $218,365; and 
high--greater than $218,365. 

[D] For total amount of Medicare Part B encounters, the ranges were as 
follows: for 2011, low--less than or equal to 664; middle--greater 
than 664 but less than or equal to 2,781; and high--greater than 
2,781; and for 2012, low--less than or equal to 682; middle--greater 
than 682 but less than or equal to 2,561; and high--greater than 2,561. 

[E] Our analysis of the number of professionals in eligible 
professionals' practices includes only a subset of professionals. That 
is, information on the number of professionals in the practice was 
missing for 85,455 professionals (15 percent) for 2011 and 75,177 
professionals (13 percent) for 2012. 

[End of table] 

Table 12 compares the likelihood of professionals with specific 
characteristics having been awarded Medicare EHR incentive payments 
for 2012 compared to 2011. For this analysis, in contrast to that for 
tables 9 through 11, we calculated relative risk ratios that indicate 
how much more likely a professional in a given category for 2012 was 
to have been awarded an EHR incentive payment than a professional in 
the same category for 2011. For example, as table 12 shows, under the 
characteristic "geographic region" for 2011, the relative risk ratio 
of 2.8 for the category "Northeast" indicates that professionals in 
the Northeast for 2012 were 2.8 times more likely to have been awarded 
an incentive payment than professionals in the Northeast for 2011. A 
relative risk ratio of 1.0 would indicate that there was no difference 
between 2012 and 2011 in the likelihood of professionals in that 
category having been awarded an incentive payment. 

Overall, professionals for 2012 were 3.1 times more likely to receive 
an incentive payment than professionals for 2011. Therefore, for each 
category, a relative risk ratio greater than 3.1 indicates a greater 
increase than for professionals overall in the likelihood of having 
been awarded an incentive payment for 2012 compared to 2011. 

In examining the relationships presented in table 12, we found the 
following: 

* The likelihood of general practice physicians, dentists, and 
podiatrists having been awarded an incentive payment for 2012 compared 
to 2011 increased less than the likelihood of specialty practice 
physicians, chiropractors, optometrists, and professionals overall. 

* Professionals who signed an agreement to receive technical 
assistance from a Regional Extension Center were 2.3 times more likely 
to have been awarded an incentive payment for 2012 compared to 2011, a 
much smaller increase than for professionals who did not sign an 
agreement and for professionals overall. 

* Professionals with the lowest total amount of Medicare Part B 
charges were 3.3 times more likely to have been awarded an incentive 
payment for 2012 compared to 2011, which was a slightly greater 
increase than for professionals with more Medicare Part B charges. 
While professionals with more charges were still more likely to have 
received incentive payments than professionals with fewer charges, 
these data indicate a narrowing of the gap between groups. 

Table 12: The Likelihood of Professionals Being Awarded Medicare EHR 
Incentive Payments for 2012 Compared to 2011, by Characteristic: 

Overall: 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 58,331 (10.2%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 183,712 (31.2%); 
Relative risk ratio[A]: 3.1. 

Geographic region: Midwest; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 16,048 (11.6%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 51,778 (36.5%); 
Relative risk ratio[A]: 3.1. 

Geographic region: Northeast; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 14,052 (11.0%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 39,945 (30.6%); 
Relative risk ratio[A]: 2.8. 

Geographic region: South; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 18,215 (9.6%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 59,464 (30.4%); 
Relative risk ratio[A]: 3.2. 

Geographic region: West; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 9,962 (8.9%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 32,257 (28.1%); 
Relative risk ratio[A]: 3.1. 

Location: Rural; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 6,332 (10.2%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 19,194 (30.7%); 
Relative risk ratio[A]: 3.0. 

Location: Urban; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 51,968 (10.2%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 164,451 (31.3%); 
Relative risk ratio[A]: 3.1. 

Professional specialty: General practice physician; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 22,094 (15.5%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 62,285 (42.6%); 
Relative risk ratio[A]: 2.7. 

Professional specialty: Specialty practice physician; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 29,259 (8.6%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 102,328 (29.3%); 
Relative risk ratio[A]: 3.4. 

Professional specialty: Chiropractor; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 1,443 (3.2%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 4,688 (10.2%); 
Relative risk ratio[A]: 3.2. 

Professional specialty: Dentist; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 23 (0.7%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 51 (1.5%); 
Relative risk ratio[A]: 2.3. 

Professional specialty: Optometrist; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 2,529 (9.2%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 8,119 (28.0%); 
Relative risk ratio[A]: 3.0. 

Professional specialty: Podiatrist; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 2,938 (20.4%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 6,151 (41.8%); 
Relative risk ratio[A]: 2.0. 

Signed an agreement to receive technical assistance from a Regional 
Extension Center: Yes; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 12,369 (23.5%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 36,843 (54.2%); 
Relative risk ratio[A]: 2.3. 

Signed an agreement to receive technical assistance from a Regional 
Extension Center: No; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 45,962 (8.8%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 146,869 (28.2%); 
Relative risk ratio[A]: 3.2. 

Total amount of Medicare Part B charges (dollars)[B]: Low; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 9,742 (5.1%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 32,281 (16.6%); 
Relative risk ratio[A]: 3.3. 

Total amount of Medicare Part B charges (dollars)[B]: Middle; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 21,583 (11.3%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 64,955 (33.3%); 
Relative risk ratio[A]: 3.0. 

Total amount of Medicare Part B charges (dollars)[B]: High; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 25,607 (13.4%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 81,650 (42.0%); 
Relative risk ratio[A]: 3.1. 

Number of professionals in practice[C]: Solo practice; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 4,354 (8.0%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 54,947 (30.3%); 
Relative risk ratio[A]: 3.8. 

Number of professionals in practice[C]: 2-10 professionals; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 12,535 (12.6%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 25,373 (37.5%); 
Relative risk ratio[A]: 3.0. 

Number of professionals in practice[C]: 11-50 professionals; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 7,354 (10.9%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 13,946 (36.2%); 
Relative risk ratio[A]: 3.3. 

Number of professionals in practice[C]: 51 or more professionals; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 18,470 (12.8%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 30,077 (42.8%); 
Relative risk ratio[A]: 3.4. 

Number of professionals in practice[C]: More than one group practice 
of different sizes; 
Awarded a Medicare EHR incentive payment for 2011 (number 
(percentage)): 12,202 (9.9%); 
Awarded a Medicare EHR incentive payment for 2012 (number 
(percentage)): 51,051 (32.9%); 
Relative risk ratio[A]: 3.3. 

Source: GAO analysis of CMS, Office of the National Coordinator for 
Health Information Technology, and Health Resources and Services 
Administration data. 

Notes: We analyzed data CMS collects pertaining to the Medicare EHR 
program through July 2, 2013. We compared the characteristics of the 
professionals who were awarded a Medicare EHR incentive payment for 
2012 and for 2011 to those of other eligible professionals who were 
not awarded a payment in the same year. The sum of the number of 
professionals listed by category may not equal the overall number of 
professionals due to missing data. 

[A] The relative risk ratios indicate how much more likely a 
professional in a given category was to have been awarded an EHR 
incentive payment for 2012 than a professional in the same category 
was to have been awarded an EHR incentive payment for 2011. A relative 
risk ratio of 1.0 would indicate that there was no difference in the 
likelihood of professionals in that category having been awarded an 
incentive payment for 2012 compared to 2011. 

[B] For total amount of Medicare Part B charges, the ranges were as 
follows: for 2011, low--less than or equal to $29,747; middle--greater 
than $29,747 but less than or equal to $134,601; and high--greater 
than $134,601; and for 2012, low--less than or equal to $49,269; 
middle--greater than $49,269 but less than or equal to $218,365; and 
high--greater than $218,365. 

[C] Information on the number of professionals in the practice was 
missing for 85,455 professionals (15 percent) for 2011 and 75,177 
professionals (13 percent) for 2012. 

[End of table] 

[End of section] 

Footnotes: 

[1] See C. J. Hsiao, E. Hing, T. C. Socey, and B. Cai, "Electronic 
Medical Record/Electronic Health Record Systems of Office-Based 
Physicians: United States, 2009 and Preliminary 2010 State Estimates," 
National Center for Health Statistics Health E-stat (2010); and A. K. 
Jha, C. M. DesRoches, P. D. Kralovec, and M. S. Joshi, "A Progress 
Report on Electronic Health Records In U.S. Hospitals," Health 
Affairs, no.10 (2010): 1951-1957. 

[2] The HITECH Act was enacted as title XIII of division A and title 
IV of division B of the Recovery Act. Pub. L. No. 111-5, div. A, tit. 
XIII, 123 Stat. 115, 226-279 and div. B, tit. IV, 123 Stat. 115, 467-
496 (2009). 

Congress defined "meaningful use" in this context to reflect that the 
user of health information technology demonstrates to the satisfaction 
of the Secretary of the Department of Health and Human Services (HHS) 
that the technology is certified and being used in a meaningful 
manner, that the technology is connected in a manner that provides for 
the electronic exchange of health information to improve the quality 
of health care, and that such information is submitted in a form and 
manner specified by the Secretary. See Pub. L. No. 111-5, § 4101(a) 
123 Stat. 467-472. To be certified, EHR technology must meet certain 
criteria established by HHS's Office of the National Coordinator for 
Health Information Technology that describe minimum related 
performance standards and implementation specifications. 

[3] See Pub. L. No. 111-5, §§ 4101-4201, 123 Stat. 467-494. Medicare 
is a federal program financing health care for individuals aged 65 and 
older, certain disabled individuals, and individuals with end-stage 
renal disease. In 2012, Medicare covered over 49 million 
beneficiaries. Medicaid is a federal-state program financing health 
care for certain low-income individuals. In fiscal year 2011, Medicaid 
covered about 70 million beneficiaries. 

[4] The HITECH Act created incentive programs for Medicare fee-for-
service, Medicare Advantage, and Medicaid. Under the Medicare 
Advantage EHR program, Medicare Advantage Organizations--private 
companies that provide Medicare health insurance coverage to 
beneficiaries for hospital, physician, and other services--receive 
incentive payments for certain affiliated professionals and hospitals 
that meet program requirements. Pub. L. No. 111-5, §§ 4101(c), 4102(c) 
123 Stat. 473-476, 484-486. In this report, we refer to the incentive 
program for Medicare fee-for-service as the Medicare EHR program and, 
where noted, the incentive program for Medicare Advantage as the 
Medicare Advantage Organization EHR program. 

[5] Acute care hospitals are hospitals described in Section 1886(d) of 
the Social Security Act, which are paid under the inpatient 
prospective payment system in the 50 states and the District of 
Columbia. The hospitals classified as critical access hospitals 
typically are very small (25 inpatient beds or fewer) and operate in 
rural areas. 

[6] Professionals must practice in one of the 50 states, the District 
of Columbia, or a U.S. insular area to be eligible for the Medicare 
EHR program. 

[7] In order to maximize the total amount of Medicare EHR incentive 
payments that could be awarded, acute care hospitals must have first 
participated in the program by the 2013 program year, and critical 
access hospitals and professionals must have first participated by the 
2012 program year. 

[8] For the Medicare EHR program, adopting or purchasing certified EHR 
technology is not sufficient to receive an incentive payment. 

[9] This assumes that all patients served were Medicare patients and 
that the hospital had at least 23,001 discharges, which is the highest 
number of discharges CMS includes in the calculation of Medicare EHR 
incentive payments. 

[10] Medicare Part B covers hospital outpatient, physician, and other 
services for persons aged 65 and over, certain individuals with 
disabilities, and individuals with end-stage renal disease. 

[11] Pub. L. No. 111-5, § 13424(e), 123 Stat. 278-279. 

[12] See GAO, Electronic Health Records: First Year of CMS's Incentive 
Programs Shows Opportunities to Improve Processes to Verify Providers 
Met Requirements, [hyperlink, http://www.gao.gov/products/GAO-12-481] 
(Washington, D.C.: Apr. 30, 2012). In our April 2012 report, we 
analyzed partial-year data that Medicare providers reported to CMS to 
demonstrate that they meaningfully used their certified EHR technology. 

[13] See GAO, Electronic Health Records: Number and Characteristics of 
Providers Awarded Medicare Incentive Payments for 2011, [hyperlink, 
http://www.gao.gov/products/GAO-12-778R] (Washington, D.C.: July 26, 
2012). 

[14] GAO, Electronic Health Records: Number and Characteristics of 
Providers Awarded Medicaid Incentive Payments for 2011, [hyperlink, 
http://www.gao.gov/products/GAO-13-146R] (Washington, D.C.: Dec. 13, 
2012). 

[15] The Regional Extension Center program was established by the 
HITECH Act and is administered by ONC to help some types of providers, 
such as those located in rural areas, to participate in CMS's EHR 
programs. 

[16] The amount of missing data on provider characteristics was 
generally low; however, in instances in which data were missing for 6 
percent or more of providers, we noted this explicitly in enclosure I 
and in tables presented in enclosures II and III, as appropriate. 

[17] In contrast to professionals, certain hospitals may receive an 
incentive payment from both the Medicare and the Medicaid EHR programs 
in the same year. Through July 2, 2013, 1,686 hospitals were awarded 
an incentive payment from both programs for 2012 and 547 hospitals 
were awarded an incentive payment from both programs for 2011. In 
addition, for 2012, 32 hospitals were awarded a total of $44 million 
in incentive payments from the Medicare Advantage Organization EHR 
program; and for 2011, 31 hospitals were awarded a total of $51 
million in incentive payments from the Medicare Advantage Organization 
EHR program. 

[18] The payment calculation for critical access hospitals is not 
subject to the 25 percent annual reduction. 

[19] For 2012, Medicare Advantage Organizations were awarded a total 
of $135 million in incentive payments from the Medicare Advantage 
Organization EHR program for 11,340 professionals; and for 2011, a 
total of $181 million in incentive payments from the Medicare 
Advantage Organization EHR program for 11,137 professionals. 

[20] In this report, we refer to the incentive program for Medicare 
fee-for-service as the Medicare EHR program and, where noted, the 
incentive program for Medicare Advantage as the MAO EHR program. 

[21] The National Level Repository is a database that contains 
information on providers pertaining to the Medicare EHR program, 
including information on providers that are registered for the 
incentive program, whether those providers have met program 
requirements to receive an incentive payment, and the amount of 
incentive payments, if applicable. The National Level Repository also 
contains some information on providers pertaining to the Medicaid EHR 
program, which we generally did not include in our analysis. 

[22] The total number of providers that received Medicare EHR 
incentive payments for 2011 or 2012 and the total amount of incentive 
payments awarded for either year could change due to provider audits 
or appeals. Additionally, our estimates for 2012 do not reflect the 
additional incentive payments that will be awarded to professionals 
who predominately furnished services in geographic areas designated as 
a health professional shortage area because CMS had not disbursed 
these amounts as of July 2, 2013. Health professional shortage areas 
are areas designated by the Health Resources and Services 
Administration as having shortages of primary medical care, dental, or 
mental health providers. 

[23] Acute care hospitals are hospitals described in Section 1886(d) 
of the Social Security Act, which are paid under the inpatient 
prospective payment system. The hospitals classified as critical 
access hospitals typically are very small (25 inpatient beds or fewer) 
and operate in rural areas. 

Hospitals are not permitted to earn an incentive from the Medicare EHR 
program and the MAO EHR program during the same year. Hospitals that 
are affiliated with an MAO are hospitals described in Section 1886(d) 
of the Social Security Act, which are under common corporate 
governance with a qualifying MAO and for which at least two-thirds of 
their discharges are of individuals enrolled under Medicare Advantage 
plans. 42 C.F.R. § 495.200. 

[24] CMS defines hospital-based professionals as those who furnish 90 
percent or more of their services in either an inpatient or an 
emergency department of a hospital. We determined whether 
professionals were hospital-based by using electronic data files 
provided by CMS that indicated for specific professionals whether 90 
percent or more of their Medicare services in 2010 were provided in an 
inpatient or emergency department of a hospital for determining 
eligibility in 2011 or whether 90 percent or more of their Medicare 
services in 2011 were provided in an inpatient or emergency department 
of a hospital for determining eligibility for 2012. 

Medicare Part B charges refers to "allowed charges" set by Medicare 
that determine the amount of payments received by professionals for 
physician, outpatient hospital, home health care, and certain other 
services. 

Professionals are not permitted to earn an incentive payment from the 
Medicare EHR program the same year an MAO receives an incentive 
payment from the MAO EHR program for the same professional. 

Professionals are not permitted to earn an incentive from the Medicare 
EHR program and the Medicaid EHR program during the same year. 

[25] Although the maximum incentive payment for 2012 that could be 
awarded to professionals practicing in a health professional shortage 
area was $19,800, our estimates for 2012 do not include the additional 
incentive payments for professionals who practice predominately in a 
health professional shortage area because CMS had not disbursed these 
amounts as of the date of our analysis. 

[26] In most cases, in order to link the information from these files 
to individual providers, we obtained zip codes and county-level 
Federal Information Processing Standard codes for hospital locations 
from CMS's Provider of Services file and zip codes for professional 
practice locations from CMS's Provider Enrollment, Chain, and 
Ownership System and CMS's National Plan and Provider Enumeration 
System. With the assistance of a zip code to Federal Information 
Processing Standard code crosswalk file that we obtained from CMS, we 
were able to determine the counties in which professionals practiced. 
When zip codes or county codes could not be determined, we were able 
to use state information to analyze information on geographic region. 

[27] ONC provided funding to support 17 Beacon Communities to build 
and strengthen their health information technology infrastructure and 
exchange capabilities. These communities were selected for various 
reasons, including the progress they had already made in adopting 
EHRs. The 17 Beacon Communities focus on specific and measurable 
improvement goals in three areas for health systems improvement--
quality, cost-efficiency, and population health--to demonstrate the 
ability of health information technology to affect local health care 
systems. 

[28] CMS's list of zip codes for health professional shortage areas 
does not contain zip codes that were only partially in a shortage area. 

[29] Information on chain membership was missing for 255 eligible 
hospitals for 2011 (5 percent) and 143 eligible hospitals for 2012 (3 
percent). 

[30] For the data obtained from the Healthcare Cost Report Information 
System, for 2011 we used the most recent record for a hospital with a 
cost report end date prior to May 1, 2012, and for 2012 we used the 
most recent record available. 

[31] We dropped data if the data were potentially unreliable--that is, 
if the number of Medicare inpatient bed days exceeded the total number 
of inpatient bed days. 

[32] We excluded data from our analysis of total charges and charity 
charges if we determined that the hospitals' data were unreliable 
because the amount of charity charges exceeded the total amount of 
charges. 

[33] Charity charges reflect the cost of providing inpatient and 
outpatient hospital services for which the hospital is not 
compensated. Information on charity charges was missing for 622 
eligible hospitals (13 percent) for 2011 and for 544 eligible 
hospitals (11 percent) for 2012. 

[34] We classified doctors of medicine and osteopathic medicine that 
specialize in family practice, general practice, or internal medicine 
as general practice physicians; all other doctors of medicine and 
osteopathic medicine were classified as specialty practice physicians. 

[35] We were unable to classify 45 professionals awarded a Medicare 
EHR incentive payment for 2011 and 90 professionals awarded an 
incentive payment for 2012 (less than 1 percent of those awarded 
payments each year) into one of our specialty categories. 

[36] The Regional Extension Center program was established by the 
Health Information Technology for Economic and Clinical Health Act and 
is administered by ONC to help some types of providers, such as those 
in rural areas, to participate in CMS's EHR programs. 

[37] We dropped data on years since the professional's degree was 
awarded if the data were potentially unreliable--that is, if the 
number of years exceeded 75. 

[38] Information on the number of years since the professional's 
degree was awarded was missing for 27,076 eligible professionals (5 
percent) for 2011 and 14,613 eligible professionals (2 percent) for 
2012. 

[39] Information on Medicare Part B claims was missing for 1,399 
professionals who were awarded a Medicare EHR incentive payment (2 
percent) for 2011 and for 4,826 professionals who were awarded a 
Medicare EHR incentive payment (3 percent) for 2012. 

[40] Percentiles were created using information on Medicare Part B 
charges for all professionals who had greater than $0 in charges for 
the year. 

[41] Percentiles were created using information on Medicare Part B 
encounters for all professionals who had at least one encounter for 
the year. 

[42] Information on the number of professionals in the practice was 
missing for 85,455 eligible professionals (15 percent) for 2011 and 
for 75,177 eligible professionals (13 percent). 

[43] For hospitals, the MAO EHR incentive payment amount for any given 
year is generally based on the hospital's annual discharges and 
Medicare share, which is the percentage of the hospital's inpatient 
bed days that were attributable to Medicare patients. For 
professionals, the amount of MAO EHR incentive payment in any given 
year is generally based on the professional's revenue for services 
provided to Medicare Advantage plan enrollees of a qualifying MAO, 
subject to an annual limit. For professionals first participating in 
2012, the amount of the incentive payment for 2012 could not exceed 
$18,000. For professionals first participating in 2011, the amount of 
the incentive payment for 2012 could not exceed $12,000. 

[44] See GAO, Electronic Health Records: Number and Characteristics of 
Providers Awarded Medicare Incentive Payments for 2011, [hyperlink, 
http://www.gao.gov/products/GAO-12-778R] (Washington, D.C.: July 26, 
2012). 

[45] We also excluded some data sources from this report that were 
analyzed in the July 2012 report. 

[46] The counts of eligible professionals in our July 2012 report 
generally excluded professionals affiliated with MAOs. 

[47] In contrast to professionals, certain hospitals may receive an 
incentive payment from both the Medicare and Medicaid EHR programs in 
the same year. Through July 2, 2013, 1,686 hospitals were awarded an 
incentive payment from both programs for 2012. 

[48] To determine how much more likely a general practice physician 
was to have been awarded a Medicare EHR incentive payment for 2012 
than a specialty practice physician, we divided the probability that a 
general practice physician was awarded an incentive payment 
(62,285/146,160 = 0.4261) by the probability that a specialty practice 
physician was awarded an incentive payment (102,328/349,004 = 0.2932). 

[49] For 2011, general practice physicians were 1.8 times more likely 
than specialty practice physicians to have been awarded a Medicare EHR 
incentive payment. To determine how much more likely a general 
practice physician was to have been awarded a Medicare EHR incentive 
payment for 2011 than a specialty practice physician, we divided the 
probability that a general practice physician was awarded an incentive 
payment (22,094/142,223 = 0.1553) by the probability that a specialty 
practice physician was awarded an incentive payment (29,259/340,914 = 
0.0858). 

[End of section] 

GAO’s Mission: 

The Government Accountability Office, the audit, evaluation, and 
investigative arm of Congress, exists to support Congress in meeting 
its constitutional responsibilities and to help improve the 
performance and accountability of the federal government for the 
American people. GAO examines the use of public funds; evaluates 
federal programs and policies; and provides analyses, recommendations, 
and other assistance to help Congress make informed oversight, policy, 
and funding decisions. GAO’s commitment to good government is 
reflected in its core values of accountability, integrity, and 
reliability. 

Obtaining Copies of GAO Reports and Testimony: 

The fastest and easiest way to obtain copies of GAO documents at no 
cost is through GAO’s website [hyperlink, http://www.gao.gov]. Each 
weekday afternoon, GAO posts on its website newly released reports, 
testimony, and correspondence. To have GAO e-mail you a list of newly 
posted products, go to [hyperlink, http://www.gao.gov] and select 
“E-mail Updates.” 

Order by Phone: 

The price of each GAO publication reflects GAO’s actual cost of 
production and distribution and depends on the number of pages in the 
publication and whether the publication is printed in color or black 
and white. Pricing and ordering information is posted on GAO’s 
website, [hyperlink, http://www.gao.gov/ordering.htm]. 

Place orders by calling (202) 512-6000, toll free (866) 801-7077, or 
TDD (202) 512-2537. 

Orders may be paid for using American Express, Discover Card, 
MasterCard, Visa, check, or money order. Call for additional 
information. 

Connect with GAO: 

Connect with GAO on facebook, flickr, twitter, and YouTube.
Subscribe to our RSS Feeds or E mail Updates. Listen to our Podcasts.
Visit GAO on the web at [hyperlink, http://www.gao.gov]. 

To Report Fraud, Waste, and Abuse in Federal Programs: 

Contact: 
Website: [hyperlink, http://www.gao.gov/fraudnet/fraudnet.htm]; 
E-mail: fraudnet@gao.gov; 
Automated answering system: (800) 424-5454 or (202) 512-7470. 

Congressional Relations: 

Katherine Siggerud, Managing Director, siggerudk@gao.gov: 
(202) 512-4400: 
U.S. Government Accountability Office: 
441 G Street NW, Room 7125: 
Washington, DC 20548. 

Public Affairs: 

Chuck Young, Managing Director, youngc1@gao.gov: 
(202) 512-4800: 
U.S. Government Accountability Office: 
441 G Street NW, Room 7149: 
Washington, DC 20548. 

[End of document]