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ACO Model Risks and Rewards

Posted on February 29, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I haven’t heard a single person say that the ACO (Accountable Care Organization) model is not here to stay. In fact, everyone that I’ve talked to is completely confident that healthcare is heading down the tracks of some sort of quality care model and away from our current fee for service model. The only real question is what form these ACOs are going to take.

With this as background, let’s consider something about ACOs that I haven’t really heard many (if any) people talking about: the risks and reward profiles of being an ACO (or part of an ACO).

I’ll save the detailed list of risks and rewards for a future post, but instead want to highlight how the risks and rewards of an ACO are quite different from our current fee for service model. In our current model, when you provide a service to a patient you have a pretty good idea of what the reward for that service is going to be. Sure, there are intricacies of insurance billing, but for the most part you know what you’re going to be paid for the services you rendered. There’s not very much risk associated with providing that service since the fee for that service is known. We could argue about whether the reward is worth it or not, but in the current model the reward is pretty solidly defined. You don’t get paid more for doing a better knee surgery than someone else. The payment is the same.

The opposite turns out to be the case in a true ACO world. Providers that are caring for a community of people will be rewarded based on the quality of care that they provide that community (at least that’s the idea). That means that providers and ACOs are taking on the risk associated with the care they provide. Bad care = less reimbursement. Better care = more reimbursement. While the associated risk is higher for providers under an ACO, so are the rewards. A provider that provides better care for their community has the possibility of making more money for the care they provided.

As an entrepreneur I must admit that the idea of getting paid more for doing something better than someone else is beautiful. This is even more true in healthcare where I love the idea of a doctor getting paid to really improve my health as opposed to getting paid for services that I may or may not need. Although, I can understand how many doctors might not feel the same way I do. Many doctors aren’t entrepreneurs. They just love medicine and patients. What are these types of doctors to do with this new and evolving ACO model for reimbursement?

I think there is a clear option for doctors that just want to practice medicine without the risk or rewards associated with the ACO model. The way they’ll get around this is likely working for someone else. There’s little doubt that there will be many organizations happy to take on the risk and rewards of the ACO model while paying a physician a salary for their work.

One thing seems clear to me: Providers take on a greater portion of risk in an ACO, but they also have the opportunity to take home a significantly higher net reimbursement.

Covered Entity Is the Only One with “Egg on their Face”

Posted on February 28, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When I first started writing this blog about six years ago, I named it EMR and HIPAA. I was working to implement an EMR at that time (this was well before EHR became in vogue) and I knew that HIPAA was a major talking point in healthcare.

Over time I’ve learned that doctors care enough about HIPAA to make sure that they don’t hear about it again. Up until now, that’s worked pretty well for most doctors. There haven’t been many HIPAA lawsuits and the government has mostly only investigated reported incidents.

We started to see a shift in this with the passing of the HITECH act which many described as giving “teeth” to HIPAA. I think we’re just now starting to see some of those teeth coming to bear with things like the OCR audits that 150 HIPAA covered entities will experience this year. That’s still a pretty small number, but the experience of those 150 is teaching us and the government a lot about areas where healthcare institutions have done a good job with privacy and security and where they likely are weak.

While at HIMSS I had the pleasure to have a brief conversation with CynergisTek CEO and chair of the HIMSS Privacy and Security Policy Task Force, Mac McMillan. I love talking with people like Mac since he is an absolute domain expert in the areas of privacy and security in healthcare. You just start him talking and from memory he’s pouring out his knowledge about these important and often overlooked topics. I loved what he had to say so much that I asked him if he’d do a series of blog posts on the OCR audits which I could publish on EMR and HIPAA. He said he was interested and so I hope we’re able to make it happen.

One simple thing that Mac McMillan taught me in our admittedly brief conversation was the changing role of the business associate in healthcare. In the past, most covered entities kind of hid behind their business associates. Many did little to verify or keep track of the policies and procedures employed by their business associates. With the new HITECH rules for disclosure of breaches and the OCR audits, covered entities are going to have to keep a much better eye on their business associates.

Mac then pointed out to me that the reason covered entities have to take on more responsibility is that they’re the ones that are going to be held responsible and take the blunt of the problem if their business associate has a privacy or security issue. I see it as the Covered Entity will be the one with Egg on their Face.

I don’t think we have to take this to an extreme. However, there’s little doubt that covered entities could do a much better job evaluating the privacy and security of their business associates and hold them to a much higher standard. If they aren’t, I wouldn’t want to be there for the OCR audit with them.

The Meaningful Use Stage 2 Proposed Rule: Highlights for Providers – Meaningful Use Monday

Posted on February 27, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Although I cannot claim to have read through the entire 455-page Proposed Rule on Stage 2 Meaningful Use, the fact that it is shorter than the 864-page rule that defined Stage 1 does not mean that it is simpler—it just requires less explanation since the basic structure of the program has not changed.

Rather than trying to summarize the Rule at this point, I am just going to point out some highlights gleaned from the presentations at HIMSS last week and from my quick skim through the document:

  • The meaningful use bar has been raised significantly for Stage 2.
  • The earliest that any providers will be subject to Stage 2 requirements is 2014; all EPs operate under Stage 1 requirements for their first 2 years of participation, regardless of when they first enter the program.
  • Most measures have higher thresholds, some have increased complexity, and new measures have been added.
  • Providers have fewer choices—there are 17 Core Measures that all providers must meet (subject to the same types of exclusions as Stage 1), all Stage 1 Menu Measures except syndromic surveillance become Core Measures, and providers will have to meet 3 of the 5 Stage 2 Menu Measures.
  • True interoperability is required—Stage 2 no longer asks providers to test their ability to exchange clinical data, but rather requires them to successfully exchange information on an ongoing basis across organizational and EHR vendor boundaries.
  • Providers will be accountable, to some degree, for actions by patients. For example, it will no longer be sufficient to make clinical information available to patients online—in Stage 2, a percentage of patients will have to actually access this information.
  • Providers will have the flexibility to purchase just the capabilities that they need to meet meaningful use—e.g., a chiropractor who does not prescribe will not have to have an EHR with ePrescribing capabilities, and a provider who is still at Stage 1 will not have to possess the meaningful use capabilities relevant to Stage 2 (until he gets to Stage 2).
  • Providers will report on 12 clinical quality measures, and there will be a broader array of measures from which to choose. One option under consideration would consolidate reporting for meaningful use and PQRS.
  • 2015 penalties can be avoided by demonstrating meaningful use in 2013, or for those who enter the program in 2014, by successfully attesting no later than October 3, 2014.

For more information, see the CMS Stage 2 Meaningful Use Fact Sheet.

Weekend Twitter Roundup – #HIMSS12 Closing Keynote Edition

Posted on February 26, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I partially understand why many choose to go home from HIMSS early. There’s certainly plenty that can be captured at HIMSS in the first couple days. Add in that coming to HIMSS for many is a job. Although, I must admit that each year on the final day of HIMSS I always feel like so many people miss out on some of the best keynote speakers they have speak at HIMSS.

This year was no exception with Donna Brazile and Dana Perino entertaining and informing. Dan Buettner was also surprisingly good with so many nuggets to think about. I admit going into it I wondered what he’d really be able to say, but it was a really interesting experience full of many points to consider.

For those that missed Dan Buettner’s keynote on Blue Zones, here are the tweets I found interesting:

Political Keynote at HIMSS 2012 and #HIMSS12 Recovery

Posted on February 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I was able to finally relax and enjoy HIMSS 2012. Although, I must admit that if I were a company that wanted to get access to talk to me, I’d look at either coming early or staying until the last day of HIMSS. However, I didn’t see any vendors left at HIMSS, but there were two really entertaining and interesting keynotes.

Today I’ll use the tweets that I collected during this morning’s political keynote to provide you some understanding of some of what was said. While they marketed it as a debate between Donna Brazile and Dana Perino, there really wasn’t a debate. I think this was actually a good thing. What we got instead of a debate was two really charming and intelligent women entertaining and educating the crowd. I’m sure many will complain that they didn’t cover much healthcare, but I personally didn’t care. Maybe I didn’t care as much since I got enough healthcare the rest of the week. Plus, I’m all about learning in all areas.

Without further ado, here’s some of the most interesting tweets from the HIMSS 2012 Keynote:

In between this keynote and the afternoon keynote, I planned to do a 1 minute video interview with Charles Webster, MD who had a hat cam. Well, the 1 minute video didn’t turn out quite like I thought it would go. I guess HIMSS finally caught up with me. Here’s the video:

Charles Webster has a really simple but powerful service called EHR Workflow. He allows someone to take some really simple to create data elements from an EHR and to create a nice looking map of where the bottlenecks in your EHR workflow exist. I encourage people to take a look at it and let me know what you think.

I may try to do a Twitter summary of the second keynote this weekend. It had some really interesting findings. Now time for my HIMSS12 Recovery!

Meaningful Use Stage 2 NPRM

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Yep, that’s the major noise you heard at HIMSS today. The Meaningful Use Stage 2 NPRM sucked the life out of HIMSS today it seems. It was funny seeing many of the major EHR vendors scrambling to get their thoughts on MU stage 2 out. I’m not sure what’s the big rush.

You can also get the meaningful use stage 2 fact sheet on CMS.gov.

I will refrain from any rush to judgment about meaningful use stage 2. It’s not going to be implemented for quite a while, so we have time to digest it properly. I’m sure we’ll cover meaningful use stage 2 a lot more to come in the future.

Until then, I’m ready for my post-HIMSS recovery. Although, both keynotes look pretty interesting tomorrow.

Social Media Day at HIMSS 2012

Posted on February 23, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I had an amazing series of meeting with really smart people. Many of my findings from those meetings will be featured in blog posts over the next month after HIMSS. I’ve come across some trends and ideas that I think readers will be really excited to hear about.

However, I’d say that today was marked by social media at HIMSS 2012 for me. Here’s a quick run down of the social media events I participated in.

First, Shahid Shah, the Healthcare IT Guy and Jennifer Dennard joined me in holding the Genius Bar in the social media center. It’s been interesting to see the variety of people that have come by the genius sessions. I think the idea of having a genius bar is a really good one and I think the HIMSS social media staff have liked the idea a lot as well. I can see it really expanding and do even better than we’ve done this year. Although, this isn’t surprising since we through the idea together a week or two before HIMSS.

Immediately after the genius bar, they held the #HITsm Tweetup. It was fantastic fun with so many familiar faces. There was only one main downside to the Tweetup. The internet connection wasn’t working and so I could only do it on my phone. The internet situation has been a problem for me for a lot of HIMSS. I can’t say how annoying it is to try and cover HIMSS and not have a decent internet connection. It’s pretty hit or miss from my experience. I’m not sure why.

Regardless of the internet connection, it was a pretty interesting experience to do a tweetup live. I almost wish it would have been a silent tweetup. Basically, random laughs and what not. Either way though, at least MelSmithJones was thinking inside the box and we got her to think inside the box. #insidejoke


In the afternoon, I participated in a Meet the Bloggers panel with Jennifer Dennard, Neil Versel and Carissa Caramanis O’Brien. I think the audience got some decent information from what was said. I must admit that one thing I loved was looking into the audience and knowing so many people who had come to hear what we had to say. A number of people said some kind things to me about the event which were really appreciated. Although, my favorite part was a lot of the individual discussions I had with so many people after the Meet the Blogger panel.

Then, to top the night off we had the really great 3rd Annual New Media Meetup. I think we had about 120 people show up to the event. The band was admittedly too loud for a really good discussion, but as someone said on Twitter at least they were a good band. A really big thanks to simplifyMD and Ozmosis for sponsoring the event. simplifyMD even stepped up and decided to add some food at the event. They were outstanding to work with and the three people who won Kindle Fire’s from Ozmosis were absolutely excited.

At the core of all the social media mentioned above is: People!

Meeting with and connecting with interesting, smart, unique, talented people is always a wonderful experience and that’s why I love social media.

HIMSS 2012 Official Day One

Posted on February 22, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As you can probably imagine, things have been extraordinarily crazy with HIMSS happening this week. My first HIMSS event actually was on Saturday and Monday I enjoyed a number of interviews and spent some time at the venture forum. As some of you know, my goal at HIMSS is mostly to spend time around really smart people having really interesting discussions. These discussions form the basis for a multitude of posts to come post-HIMSS. Unfortunately, that means much of the best things I learn and talk about at HIMSS won’t come until the weeks and sometimes months after HIMSS.

If you want to get a bit of an idea of the insane activity that’s happening at HIMSS, you should browse through the various press releases on EMR and Health IT News. David has done an amazing job posting all the various press release announcements that are sent out before and during HIMSS. You’ll need to go through a few pages of press releases, but even browsing through the titles offers an interesting perspective on the industry and what it’s trying to communicate.

Also, this year I decided to do some more videos at HIMSS. I wanted to do something that was simple, but interesting. Plus, I wanted it to be a series of videos that when watched video after video provided something more. Thus, I decided to do what I’m calling 5 Questions with EHR Vendor Executives at HIMSS12. I posted the first video with Dr. Andre Vovan, Founder of Mitochon. I think I’ve already done 4 more that I’ll be posting on EMR and EHR over the next little while. I hope you find the videos as interesting as I do.

I also would be remiss if I didn’t post one of the most incredibly things I learned at HIMSS. It has almost nothing to do with Healthcare IT, except for the fact that Inga at HIStalk LOVES shoes and so shoes are relevant at HIStalkapalooza. I guess some other people take shoes very seriously as well. I learned that Timur Tugberk from DrFirst was wearing an $1250 pair of shoes. When he said this, Brittanie from ESD said you know that’s twelve hundred and fifty dollars, not twelve dollars and fifty cents. Of course, with that background, I of course took a picture for others to see:

Funny thing is. I bet I haven’t spent $1250 in my entire life on shoes. I guess different strokes for different folks.

Are Retiring Physicians Eligible for Incentives? – Meaningful Use Monday

Posted on February 20, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

As the industry anxiously anticipates the Proposed Rule for Stage 2 meaningful use—likely expected during HIMSS this week—many providers are still struggling to understand meaningful use Stage 1. So while we wait for the impending news story to break, let me address another question that was recently posed by a reader. 

Q: Can a physician attest and earn a Medicare EHR incentive for his second reporting year if he will be retiring in the middle of the year? 

A: To my surprise, this situation is not explicitly addressed in the regulations. One would think that a physician who works full time for part of the year would be just as eligible as one who works part time for the full year. The retiring physician, however, faces two obstacles: 1) The regulations require that an EP report for an entire calendar year after receiving a first meaningful use payment. 2) The EP must have an active enrollment record in PECOS (Medicare) to be eligible to attest—if he retires and withdraws from Medicare, he would no longer have active status. These factors suggest that a retiring physician is not eligible for an incentive (unless, of course, he times his retirement for the end of the year!)

In lieu of a definitive answer to the question, however, I offer the following food for thought: 1) Couldn’t the retiring physician simply wait until December 31 to attest and then report on the full calendar year? 2) What if he simply postpones surrendering his PECOS enrollment until the end of the year? (According to a local Medicare contractor, nothing prohibits him from doing that even though he would no longer be submitting claims.) If there are countervailing reasons not to do this that readers are aware of—and there may well be—please share your insights by commenting below. 

(Note: This is not an issue for retiring physicians in their first incentive year since they attest immediately upon the conclusion of their 90-day reporting period.)

Weekend EHR and Meaningful Use Roundup – Justin Barnes #HIMSS12 Edition

Posted on February 19, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s Sunday and the excitement to see old friends and hear interesting things at HIMSS 2012 is just around the corner. The #HIMSS12 hashtag is off the charts with people flying into Las Vegas and others talking about what they’re doing, seeing, hearing and expecting from HIMSS Las Vegas.

Most people on Twitter are quite excited for HIMSS (as am I), but a few have said that people won’t be missing much. I thought about it for a minute and realized that the thing I love most about HIMSS is meeting really smart people. With 37,000 people likely to attend HIMSS 2012, there are plenty of smart people to meet and connect with at HIMSS.

Justin Barnes, VP at Greenway Medical, is one of the smart people I like to talk with at HIMSS. Turns out that tonight he was sharing some of that wisdom, information and perspective on Twitter tonight. So, this EMR and Health IT Twitter roundup is the Justin Barnes edition.


I wish he would have broken this out into ambulatory doctors versus hospitals. $3 billion of ~$36 billion projected. I guess they’re expecting a windfall next year?


Is a billion dollars at stake in the ICD-10 delay decision? Regardless of the exact amount, it shows you the magnitude of the ICD-10 delay announcement.


Someone on Twitter asked if it could be delayed past Tuesday. Neil Versel from Meaningful Healthcare IT News answered well: “Never underestimated bureaucracy.”


That’s a little surprising to me that so many Nurses and PA’s got paid so much since they only qualify under Medicaid. I’m glad to hear it.


When the number is totally written out, that’s a lot of 000’s and that’s only millions.

Looking forward to seeing many old friends and making many new friends at HIMSS this week.