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Does Healthcare IT Need Stability?

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Last night during one of my favorite TV shows, Charlie Rose, he interviewed a guy about the economy. One of the discussion points that came out of this interview and that I’ve heard a lot in all the discussions about the economy is having some stability to the economy. Many argue that one of the biggest things holding our economy back is all the unknowns. When there are unknowns companies get paralyzed and hold back doing things they’d do if the economy felt stable.

I wonder if we’re experiencing the same thing in healthcare IT? Could we use some stability in healthcare IT?

Think about all the various unknowns that exist in healthcare IT. Let’s start with ICD-10. The pending ICD-10 implementation date is looming, but that date has been pushed back so many times it’s still unknown if it’s really going to happen this time. That’s the opposite of stability.

I’m sure that many also wonder if the same will be the case with EHR penalties. Will the EHR penalties go into effect? What exceptions will be made for the EHR penalties? I could easily see the EHR penalties being delayed, but then again what if they’re not?

Is it hard for anyone else to keep up with what’s happening with meaningful use? I do this every day and so I have a pretty good idea, but even I’m getting confused as it gets more complex. Imagine being a doctor who rarely looks at meaningful use. So, we’re in meaningful use stage 1, but meaningful use stage 2 is coming, unless you didn’t start meaningful use stage 1 and then meaningful use stage 2 won’t come until later. Oh, and they’re making changes to meaningful use stage 2. That’s right and they’re also coming out with meaningful use stage 3. However, don’t worry too much about meaningful use stage 3 because a lot of people are calling for it to be slowed down. So, does that mean that meaningful use will be delayed? Now how does the meaningful use stages match with the EHR certifications? Which version of my EHR software does which stage of meaningful use?

I think you get the picture.

Of course, I haven’t even mentioned things like ACO’s, HIE’s, 5010, HIPAA, RAC Audits, Medicare/Medicaid cuts, or healthcare reform (ACA) to name a few others.

It’s a messy healthcare IT environment right now. We could definitely use some stability in healthcare.

February 12, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

ACOs (Accountable Care Organizations)

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ACO’s Built Around Primary Care Not Payers
It’s always quite interesting when a non-healthcare journalist covers healthcare. The above title comes from this article on NJBiz.com. In the article they offer the following interesting ACO stats (as of Sep 2011):

-51% of all ACOs are buist as joint ventures between doctors and hospitals
-20% of ACOs are physician led
-18% of ACOs are hospital led
-75% of hospitals surveyed were not planning on participating in ACOs
-13% of hospitals are already participating in ACOs


Then, the article offers this insight into the ACO battle between payers, physicians and hospitals:

The report also noted that hospital- and physician-led ACOs tend to focus more on primary care than acute care, but Horizon Blue Cross Blue Shield’s partnership with Optimus is set up to promote primary care based on patient-centered medical home models, according to spokesman Tom Vincz.

“Horizon ACO arrangements include incentive payments to support improved patient care coordination and fund other activities to further transform offices into patient-centered practices,” said Horizon in a statement from Vincz. “Entities that Horizon collaborates with are given other valuable resources, such as timely, population-based data, to help them deliver more effective and efficient care to their patients.”

Since I consider myself a physician advocate, it seems appropriate for me to add in a quote from a blog post Kerry A. Willis, MD did on KevinMD:

During the PHO debacle a few years ago, I reminded our physicians that the letters should represent the ownership and direction that these organizations should take as they developed. I frequently offered that they were really pHO’s with Big hospitals and Big organizations with little physician control over the direction and quality that was important to us.

I fear that the same is true with ACOs. If we are not vigilant in their formation and direction, then they will become AcOs with physicians being a small part of their governance but very accountable to their owners. They will be dependent on the revenue streams that spring from them. I see scenarios where physicians will profit but then be caught in a spider’s web of their own design where they will be told how to practice and what kind and amount of care they can provide. I guess you could claim that I don’t trust insurance companies and you would be wrong. I do trust them. I trust them to do what is best for the corporate profits and the nonprofit executives’ with bonus clauses at the end of a successful year.

I fear that when it comes to ACOs many physicians are sitting on the sideline. We saw what happened with EHR incentive money and meaningful use when more doctors weren’t involved in the process. There were requirements that didn’t make any clinical sense. I can see the same thing happening with ACOs if doctors don’t get involved.

It’s a rapidly changing ACO environment, and my hope is that many smart physicians will add their voice to the mix. Otherwise, the shift to hospital owned practices will continue and doctors won’t have much of a choice but to be beholden to a big company.

August 28, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

88 New ACO Organizations – What Does That Mean?

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It has been a really interesting couple months for those interested in ACO’s (Accountable Care Organizations) and healthcare. I love how Gregg Masters of ACO Watch called the ACO the “Child of the ACA (Accountable Care Act).” He even declares the SCOTUS supreme court ruling as a big battle won for the ACO. I certainly can’t disagree with him when it comes to the government ACO initiatives. The loss of ACA would definitely hamper much of the government’s work on ACOs. Although, he also acknowledges that ACA is still up in the air pending the Presidential election. ACA is directly in the republican cross hairs.

Politics aside, the ACO program is going forward. CMS recently named 88 new Accountable Care Organizations (ACOs) that will take part in the Medicare Shared Saving Program (Originally it was 89 ACOs, but one organization dropped out).

You can see the full list of ACOs on the press release linked above, but I really like this image that The Advisory Board Company put together that shows the location of the various ACOs across the US (click image twice for full size):

I think this represents a pretty good distribution across the country. However, there are a few things that I find a bit disturbing about the organizations participating in the government ACO programs. The first is that many healthcare organizations that you think would be perfect fit for an ACO aren’t participating. Kaiser and IHC come to mind. I’ve heard that both organizations are very interested in ACOs, but not the government ACO programs. I think this is a bad sign for the government sponsored ACO programs.

The second is that only five of the ACOs applied for the version of the Medicare Shared Savings Program where they have a chance to earn a higher share of any savings, but they’ll also be accountable for any losses if the cost o the care increases. You might take a look back at my ACO Risks and Reward post. These five organizations have gone all in with the ACO program. With that said, I wonder why only five of them chose to participate in it? Shouldn’t we want more organizations to have some accountability and responsibility if they don’t improve care and lower costs?

As I have pointed out before, the ACO movement is happening and is not likely to slow down. Even if ACA or other government legislation is repealed, the move to ACOs is going to happen. With that knowledge and some of the comments above, it makes me wonder if the government should be the one funding an ACO initiative. Will their involvement help or hurt the overall ACO movement?

I’ll be interested to see how it goes for these new ACOs. As we’ve seen with EHR and meaningful use, we’ll have to be careful to filter through the messages coming out of CMS about the success or failure of the ACOs. As they progress we’re going to have to reach out to the ACOs and hear the first hand stories. If you’re an organization that’s participating, we’d love to hear your thoughts in the comments.

July 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

SCOTUS Decision and Healthcare IT

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For those living in a hole that haven’t read about the SCOTUS supreme court decision that was issued today, here’s a good one paragraph summary of their decision from a post by The Atlantic:

In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.

There have been a lot of interesting reactions to the SCOTUS decision. Many of them revolve around the politics of the decision. We’ll obviously avoid the political side of the discussion for the most part. I did find HIMSS response to the ACA Supreme Court decision quite interesting. They are mostly grateful that some of the uncertainty is gone so we can move forward in healthcare. Plus, they remind people that health IT has had bipartisan support in Washington despite Obamacare’s obviously partisan issues.

Personally, I think that this decision (regardless of which way it went) will not have a major effect on the healthcare IT and EHR world. Most of the major happenings in healthcare IT and EHR aren’t related to Obamacare. There are a few places that impact it, but most are relatively innocuous.

My biggest concern with the SCOTUS decision is how it will impact healthcare reimbursement in general. Plus, the ACA uncertainty is still there since if the Republicans take control in Washington, then you can be sure that they’re going to repeal ACA as one of the first things they do. This uncertainty could affect the health IT decision making by many institutions.

I’d be interested to hear what other impacts people think the SCOTUS ruling will have on healthcare IT. I do agree with HIMSS that I’m glad we have a decision and can at least move forward with that knowledge.

June 28, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.