From 2006 through 2013, physician organizations just barely increased their adoption of chronic care management processes (CMPs) found to improve outcomes. Over that period, they went from using an average of 3.9 to 4.5 of the 20 CMPs available, despite evidence of benefit for all of them.
A new paper by Hector P. Rodriguez, PhD, MPH, and others in the Milbank Quarterly used data from three national surveys, covering more than 1,000 physician practices of different sizes, to look behind such low adoption figures, revealing a significant degree of churn. They found that many organizations tried CMPs only to abandon them, a process sometimes called "exnovation" (in contrast to innovation, the adoption of new methods).
The researchers also found that adoption and abandonment of CMPs differed based on specialty and the type of process being adopted. For example, CMPs providing feedback on quality of care and patient reminders for preventive and chronic care were those most likely to be dropped. Nurse care management CMPs, conversely, were highly retained among practices of all specialties analyzed.
The researchers found other intriguing trends. For example, practices with a high and increasing proportion of revenue from Medicaid removed significantly more CMPs over time.
"Our post hoc explanation is that Medicaid provider reimbursement may not sufficiently incentivize the retention of CMPs and that high and increasing dependence on Medicaid reimbursement results in exnovation of CMPs by early adopting organizations," Rodriguez and colleagues wrote.