Health affairs
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The Affordable Care Act is transforming American federalism and creating strain between the states and the federal government. By expanding the scale of intergovernmental health programs, creating new state requirements, and setting the stage for increased federal fiscal oversight, the act has disturbed an uneasy truce in American federalism. This article outlines a policy proposal designed to harness cooperative federalism, based on the shared state and federal desire to control health care cost growth. The proposal, which borrows features of the Medicare Shared Savings Program, would provide states with an incentive in the form of an increased share of the savings they generate in programs that have federal financial participation, as long as they meet defined performance standards.
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Expanding the use of interoperable electronic health record (EHR) systems to improve health care delivery is a national policy priority. We used the 2010-12 National Ambulatory Medical Care Survey--Electronic Health Records Survey to examine which physicians in what types of practices are implementing the systems, and how they are using them. We found that 72 percent of physicians had adopted some type of system and that 40 percent had adopted capabilities required for a basic EHR system. ⋯ As of 2012, physicians in rural areas had higher rates of adoption than those in large urban areas, and physicians in counties with high rates of poverty had rates of adoption comparable to those in areas with less poverty. However, small practices continued to lag behind larger practices. Finally, the majority of physicians who adopted the EHR capabilities required to obtain federal financial incentives used the capabilities routinely, with few differences across physician groups.