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Scariest Health IT Regulation – Healthcare IT Superlatives

Posted on November 3, 2014 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 thought it would be fun to look at a bunch of Healthcare IT Superlatives (best, scariest, cutest, smartest, funniest, etc etc etc). I imagine this will be a series of blog posts that never stops. If you’d like to see me write about a specific healthcare IT superlative, let me know in the comments or on my Contact Us page. I always like to cater to readers. Then, I at least no one person will find the post useful. Although, if one person finds it useful, it’s very likely that thousands of others are interested as well.

The first Healthcare IT Superlative we’ll consider is: Scariest Health IT Regulation

This is a challenging topic since healthcare is so burdened by regulation. I’m going to use a pretty broad interpretation of what I’d consider a healthcare IT regulation, but I’ll admit that I’m not as familiar with the medical device or pharma industry regulation. If you have experience in either of those, I’d love to hear what regulations in those industries is the scariest regulation.

When I think about all the various healthcare IT regulations, I have to narrow the scope down to the regulations that have the most over arching reach. That basically leaves me with ACO/Value Based Reimbursement, Meaningful Use, and HIPAA. Certainly there are plenty more that could be listed, but it’s not as scary for me if they aren’t large regulations that impact the majority of the healthcare system.

Of all of these, I’m most scared of ACO/Value Based Reimbursement. The worst part of any regulation is ambiguity. ACO and value based reimbursement is so vague right now that I don’t think anyone know where it will really end up going. That’s really scary for me and is likely scary for most healthcare organizations. It’s really hard to plan for something that’s vague and ambiguous.

Furthermore, the move to value based reimbursement and ACOs is likely going to have the biggest economic impact on healthcare. This doesn’t mean that every doctor and healthcare organization is going to lose when it comes to value based reimbursement. Definitely not. There are going to be a bunch of winners and losers. Some will really benefit from ACOs and some will suffer. However, my gut tells me that there’s going to be more losers than winners. That’s pretty scary to consider with all the other challenging dynamics at plat in healthcare today.

There you have it. What healthcare regulations are scaring you the most? Which regulations keep you up at night? I look forward to hearing your thoughts.

ACO’s and the Tech Needed to Be Ready

Posted on April 22, 2014 I Written By

The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff
For those not familiar with ACOs (Accountable Care Organizations), I want to provide some insight into ACOs and how a medical practice can better prepare themselves for the coming shift in reimbursement, which is epitomized by the ACO. This is a challenging subject since the ACO is a somewhat nebulous idea that’s rapidly changing, but hopefully I can provide you some strategies that will help you be prepared for the coming changes.

You may remember when we talked in a previous post about the Value Based Payment Modifier and its impact on healthcare reimbursement. As we talked about in that post, healthcare reimbursement is changing and CMS is looking to only pay those providers who are providing quality care. As part of this movement, an ACO is an organization that works on behalf of a community of patients to ensure quality care.

The metrics of how they’ll measure what they reimburse and what they consider quality care are likely to rapidly change over the next few years while CMS figures out how to measure this. However, one key to being ready for this shift is that you’ll need to be part of an organization or group of providers that will take accountability for a patient population.

In some areas of the country, the hospitals are leading these organizations, but in other areas groups of physicians are coming together to form an ACO of just physicians. Either way can work. The key is that the members of these groups are going to each share in the reimbursement the group receives for improving the quality of healthcare patients in the community receive.

Also worth noting is that membership in an ACO isn’t necessarily a prerequisite for value based reimbursement. Whether you choose to be a member of an ACO or not, you’re going to be impacted by value based reimbursement and will need to be ready for the change. Not being ready could lead to lower reimbursement for the services you provide.

While it’s great that organizations of doctors are coming together to meet the need for ACOs, much more is going to be needed to do well in an ACO reimbursement world. The reality is that an ACO can’t exist without technology. Don’t even think about trying to meet the ACO requirements without the use of technology. ACOs will base their reimbursement on trackable data that can be aggregated across a community of providers that are likely on hundreds of different systems. Try doing that on paper. It just won’t happen.

In fact, many people probably think that their EHR software will be enough to meet the needs of the ACO as well. I believe this to be a myth. Without a doubt, the EHR will play a major role in the gathering and distribution of the EHR data. However, unless you’re a homogeneous ACO with providers that are all on the same single instance of an EHR, you’re going to need a whole suite of services that connect, aggregate, and interpret the EHR data for the community of patients. Add on top of that the communication needs of an ACO and the care manager style tracking that will need to occur and it’s unlike your EHR is going to be up to the task of an ACO. They’ll be too busy dealing with meaningful use and EHR certification.

Let me highlight three places where an ACO will need technology:

Communication
One of the key needs in an ACO is quality communication. This communication will happen provider to provider, provider to care manager, provider to patient, and care manager to patient and vice versa. You can expect that this communication will be a mix of secure text messaging and secure emails. In some cases it will be facilitated by a patient portal, but most of the secure messaging platforms for healthcare are much slicker and more effective than a patient portal that so far patients have rarely used.

Are you using a next generation secure messaging system to communicate with other providers, your staff, and the patient? You’ll likely need to use one in an ACO.

Provider Data Aggregation
Much like paper charts won’t be enough in an ACO world, faxed documents won’t be enough either. Providers in an ACO will need to have patient data from across the entire community of ACO providers. At a minimum providers in an ACO will need to have their EHRs connected with Direct, but most will need to have some sort of outside HIE that helps transfer, aggregate and track all the data that’s available for a patient in the ACO.

The ACO and doctor will really benefit from all the patient data being available at the click of the button. Without it, I’m not sure that ACOs will be able to meet the required quality measures.

Patient Data Aggregation
While all of the providers will need to be sharing their patient data, I think most ACOs will benefit from aggregating patient data as well. At first the ACO won’t be aggregating all of the patient generated data that’s available. Instead, they’ll find a slice of their patient community where they can have the most impact. Then, they’ll work with those patients to improve the care they receive. This is going to require ACOs to receive and track patient generated data. Without it, the ACO won’t have any idea how it’s doing. With so many patients on mobile devices or with access to the internet, what an amazing opportunity we have to really engage with patients.

Those are just a few of the ways technology is going to be needed for the coming changes in healthcare reimbursement and the shift towards value based care in things we call ACOs. Far too many providers are sitting on the sidelines while they let ACOs settle into place. What a missed opportunity. The fact that the ACOs are rapidly changing means that if you participate and make your voice heard, you can help to shape the direction of them going forward. We definitely need more doctors involved in these conversations.

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.

The Fundamental Challenge of ACOs

Posted on March 31, 2014 I Written By

Kyle is Founder and CEO of Pristine, a company in Austin, TX that develops telehealth communication tools optimized for Google Glass in healthcare environments. Prior to founding Pristine, Kyle spent years developing, selling, and implementing electronic medical records (EMRs) into hospitals. He also writes for EMR and HIPAA, TechZulu, and Svbtle about the intersections of healthcare, technology, and business. All of his writing is reproduced at kylesamani.com

I’ve been openly bullish on ACOs and capitated payment models. The only way to achieve the triple aim – quality, cost and access – is to create a system that is structurally incentivized towards those ends. The fee-for-service model will never be structured in a way that incentivizes the triple aim. On the other hand, ACOs do.

Early ACO data is mixed. Although some organizations succeeded in lowering costs and improving outcomes, about 1/3 dropped out of the ACO program entirely, and another 1/3 reported no significant cost or quality changes. Only 1/3 were “successful.”

Why? Why did some organizations succeed where others failed? What did each organization do differently? It’s been proven that some organizations can succeed under this model. But not everyone.

ACOs are disruptive to fee-for-service payment models. ACOs invert incentives. They invert how every employee should think about their job in the context of the larger care delivery system. In ACOs, healthcare professionals are implicitly asked to think about preventative care, which tends to lead towards both cost and quality improvements. On the other hands, in a fee-for-service model, healthcare professionals are only incentivized to simply treat the patient in front of them with no regard for prevention or cost.

When the board of directors of a given organization recognizes the need to change the course of a business, the board usually replaces the CEO. After a new strategy is devised, the new CEO typically replaces most of the executives and lays off a significant number of the existing staff. This accomplishes a few things:

1) reduces the burn, making the organization leaner and more capable of pivoting
2) replaces lots of senior and middle management, who were trained and wired around the old business model, and who may conspire against the new model if they don’t believe in it
3) sends a signal to the remaining staff that management is serious about change

Although this plan doesn’t guarantee success, it’s fairly common in large organizations because it can create impetus to break from the inertia of the status quo. The only thing worse than going after the wrong business model is maintaining one that’s failing.

This of course begs the question, how are providers adopting ACOs? Management at provider organizations that have adopted the ACOs are early adopters. They are pioneers. They are leaders. They can see a new, better, ACO-based future. The last thing management at these organizations is going to do is fire themselves after deciding to transition to an ACO.

In light of the above, I am particularly impressed by the early success of the ACO program. Only 1/3 dropped out. Given the fundamental change at hand, I would consider the early data a harbinger of better changes to come. I suspect that almost all of the remaining ACOs will see more significant improvements in years 2 and 3 as they mature and refine processes around value.

Why Everyone Better Learn About ACOs

Posted on March 24, 2014 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.

While I wasn’t working in healthcare at the time, I’ve heard a number of doctors say that doctors missed out on being part of the HMO process. Their voice wasn’t part of the process and they suffered as a consequence of that decision. As I consider that idea, I wonder if doctors aren’t in the same position again with ACOs.

I was reminded of this as I was reading through this whitepaper called ACO & Collaborative Care – The Basics. The whitepaper digs into a number of good ACO discussions, but I was struck by one of the opening phrases:

Health reform IS REAL and NOT GOING away.

That struck me, because I think many doctors are just hoping that this shift to ACOs and value based reimbursement will just go away. Certainly some of this hope is founded since ACO is such a nebulous concept and we’re not sure how it’s going to be implemented. However, just because a concept isn’t totally defined doesn’t mean that it’s not going to be the future of healthcare. I assure you that this shift in reimbursement isn’t going anywhere.

The fact that ACO is a nebulous concept is exactly why doctors should get involved in the process of defining an ACO. When there’s uncertainty, there’s opportunity. The question is whether the opportunity is going to be taken by doctors or by someone else. Ideally all parties will be involved and there will be a give and take. However, I think currently physician voices are underrepresented and they’ll suffer for it.

One other thing that the ACO & Collaborative Care – The Basics whitepaper points out nicely is that you can’t just go out and buy an ACO. There’s no off the shelf ACO solution that will solve your problems. It’s not a software. It’s not a program. It’s not an organization. It’s likely going to include all of those things and that means that it takes some planning, coordination and collaboration. You’re not going to be ready for it if you’re not part of the ACO conversation.

What’s Next TEDMED?

Posted on April 24, 2013 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.

One of the beauties of TEDMED is that they do a really professional job recording the event and sharing the recorded video with the world. For those who missed it or want to re-watch certain sessions, you can find the full TEDMED session recordings available online. Thanks to Xerox, I was able to cover the event in person. If you’re looking for a cliff notes version of TEDMED, check out my previous posts covering the event:

As I think back on TEDMED, I’m stuck wondering about a major healthcare group I would have loved to see on the TEDMED stage: hospital and healthcare administrators. No doubt they’re doing some really innovative things in healthcare, but yet we didn’t see any of them on stage talking about how to innovate the nuts and bolts of healthcare.

It’s not that many of these hospital and healthcare administrators weren’t at TEDMED, because they were there in force. I met with many of them and saw many of them tweeting about TEDMED like this tweet from New York Presbyterian CIO, Aurelia Boyer:

I hope that many more hospital and healthcare administrators will “Step Out” and speak at TEDMED like Hospital CIO Bill Reiger did at The Breakaway Group’s Healthcare Forum at TEDMED. It’s great that hospital and healthcare administrators are listening and learning at TEDMED, but they also have a voice that needs to be heard.

Looking forward to the next year in healthcare let me suggest three topics I hope we’ll find at TEDMED 2014:

Accountable Care Organizations (ACOs) – ACOs represent the core of a rapidly changing healthcare reimbursement environment. This change will fundamentally alter healthcare as we know it. ACOs are a hard topic to package into a slick presentation, but there are stories to be told about the impact for good and bad of ACOs. We often hear: “If you’ve seen one ACO, you’ve seen…one ACO.” How about we start with one ACO TEDMED talk and expand from there?

Interoperability – Almost nothing could provide more value to healthcare than true data interoperability. There are literally hundreds and possibly thousands of people affected every day by the lack of healthcare interoperability. The challenges to interoperability are real and powerful, but I see a shifting tide where organizations are finally looking to embrace interoperability and its inherent benefits. TEDMED would be the perfect place to highlight the interoperability success stories that will inspire others to follow.

Patient Engagement – A number of sessions at TEDMED 2013 began the discussion of the shifting role of patients in healthcare. I won’t be surprised if 2014 becomes the Year of the Patient. Like a slow moving ship that’s impossible to stop, the patient is finally becoming the center of healthcare. ZDoggMD’s comment at TEDMED highlights this shift from the physician perspective, “I went in to medicine to do things for patients, not to patients.” Patients at the center of healthcare is a message that needs to be shared.

In true TEDMED form, it only seems appropriate that I also suggest a collaborative musical act that could perform at a future TEDMED. If you’ve never heard of The Piano Guys, they’re great. Where else have you seen a piano and cello collaboration perform Coldplay, Usher, and Adele? Although, their real genius is when they take two songs and mix them into one beautiful piece like they did with Love Story Meets Viva La Vida. I can think of a few areas of healthcare that could benefit from some unexpected collaboration.

What did you take away from TEDMED 2013? Have you had a change in perspective personally or professionally? What topics should we see at future TEDMED events?

You can hear more reflections from TEDMED and predictions for the future of healthcare during the May 2 at 2 p.m. ET “Xerox ‘Ask the Experts’ Episode: Looking Ahead After TEDMED” Google+ Hangout that I’m hosting and participating in. Click here for more details and to watch.

Read more coverage from TEDMED from Xerox on the Real Business at Xerox Blog and follow @XeroxHealthcare.

ACOs Make Healthcare Providers More Like Health Insurers

Posted on April 16, 2013 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’m not sure why I haven’t seen more people talking about this idea. When you start to look at the ACO financial models, I think there are some real comparisons between what health insurance companies do with patient populations and what ACOs will have to do with patient populations.

Should ACOs be looking to insurance companies on how to manage patient populations?

Another interesting dynamic at play here is that many insurance companies are acquiring provider organizations. Is this because insurance companies want to leverage their expertise with patient populations to get at the ACO money that is getting ready to flow?

I admit that I’m not an expert on all the various methods of insurance companies. Maybe they were under a very different model than ACOs, but even then it seems like the principles could still apply. Even just starting with the way insurance companies use data to analyze patient populations. Shouldn’t that same data analysis be able to be applied to an ACO?

I’m sure just thinking about the idea makes most doctors wonder if they want to keep practicing medicine. No doctor I know wants to be in the insurance business. They want to care for patients. Anything that takes them away from that is a distraction.

What are your thoughts? Can an ACO learn from insurance companies?

Can the Benefits of Hospitals Acquiring Practices Be Achieved By Other Means?

Posted on February 13, 2013 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’ve regularly talked about the current healthcare environment of hospitals acquiring physician practices. This trend is occurring at a really rapid rate, but in an email exchange I had recently with Dave Chase from Avado I started asking myself if the benefits of a consolidated group of providers could be achieved by other means.

At the core of the current trend is a little reimbursement loophole that many hospitals have been exploiting. I wrote about this loophole in a post on Hospital EMR and EHR called Reasons Hospitals Acquire Medical Practices. Considering this reimbursement loophole, I think there is a little that can be done to discourage hospitals that want to try and increase revenue through this loophole.

At some point Medicare is going to catch up with this and close the loophole. Once that happens, it’s worth considering the other benefits of being part of a large organization as opposed to being a solo practice. Plus, can those benefits be achieved through other means than fully acquiring a practice? This is particularly important as doctors that are currently working for hospitals choose to go back out on their own and for those organizations who haven’t already gotten on the practice acquiring bandwagon.

I think the most pressing reason that practices are interested in relationships with hospitals is based on the changing reimbursement models. It will be impossible to access the ACO money that’s coming without tight ties to a large number of organizations. One way to achieve this is for a healthcare organization to acquire all of the various healthcare organizations that will make up an ACO. I think that’s part of what we’re seeing now and I’ve discussed before how this might be the way hospitals avoid the cycle of doctors leaving. Although, we’re already seeing signs of doctors leaving for new medical models.

This seems like a pretty expensive proposition for hospitals to acquire practices just for the doctors to go back to private practice. Which makes me wonder if the benefits of an acquired practice can be achieved through software and relationships? As we’ve discussed before, interfaces in healthcare are quite hard to do. So, once you’ve been able to create that interface with a clinic or hospital, then you have some pretty solid lock in with that organization.

Although, I’m pretty sure that Dave Chase (which inspired this idea) would take this idea one step further. Imagine that most of the patients used one portal to interact with your local healthcare community. Could that portal facilitate your ACO efforts? Once the majority of patients are in that portal, will anyone in the community want to be somewhere else? There’s real lock in that can occur once patients are engaged with healthcare institutions. This occurs with the patients and with the healthcare organizations that are engaging with those patients.

I think it will be interesting to see if software can facilitate some of the same benefits to hospitals that they get from acquiring physician practices.

The Fiscal Cliff of Primary Care

Posted on December 20, 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.

The Hello Health blog has a really interesting article up discussing what they called the Primary Care Fiscal Cliff. The thing I like most about the post is the data they provide on what’s happening with primary care doctors. Take for example this list of statistics:

  • Primary care practice income rose just $500 from 2008-2011
  • Operating expenses of a practice continues to rise each year
  • Primary care physicians can spend an average of 13 hours a week of uncompensated care worth over $30,000 in lost revenue a year
  • The cost of a traditional electronic health record can easily exceed $20,000 in the first year with a 5-year projected cost approaching $50,000 per physician

I’m not sure that the US government’s fiscal cliff has much relationship to the primary care doctor fiscal cliff (except for the possible Medicare cuts), but it’s very safe to say that primary care doctors are in a real financial predicament.

In the Hello Health post they suggested from their own research that practice finances and EHR are the two issues keeping primary care physicians up at night. I’m sure these findings won’t be a surprise to any primary care doctors. Plus, it’s worth noting that the finances of a primary care practice are tied to an EHR in many ways.

I have often questioned how much influence the government EHR incentive money has had on getting doctors to adopt EHR. Whenever I do, I usually get a response from a primary care doctor saying that they wouldn’t be implementing an EHR if it weren’t for the EHR incentive money and that they were depending on the EHR incentive money to help cover the new EHR expense.

In my recently started EHR benefit series I’m hoping to expand the thinking when it comes to EHR revenue implications. There are still tens of thousands of primary care doctors that need to implement an EHR or replace their existing EMR. Understanding the financial ties to EHR will help a practice ensure a more successful EHR implementation.

At the core of the question is whether EHR software is a financial benefit or a financial loss. The cop out answer to that question is that it depends on how you implement the EHR and which EHR you implement. I wish someone would take the time to study the top 20 EHR companies and evaluate how practices have done pre-EHR implementation and post EHR implementation. Plus, they’d need to take into account the cost of an EHR. That type of study would produce a lot of interesting EHR data.

My gut feeling having participated in numerous EHR implementations and heard from thousands of other EHR implementations is that the result is usually a wash. In most EHR implementations I don’t think there’s a net financial gain or loss. There are outliers on both sides of that spectrum, but I think for most it has some pros and some cons.

With that said, I think there are long term benefits to a practice that has an EHR. While the immediate financial returns may not come, I think that the EHR in a practice is going to be essential for many of the financial gains a practice wants to achieve in the future. The most obvious example is becoming part of an ACO. Can you really get the financial benefits of being in an ACO without an EHR? I think the answer will likely be no. You need the EHR data to obtain and report on the ACO improvements your practice achieves.

EHR Vendor as ACO

Posted on December 18, 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 was doing my interview with Dr. Jonathan Bertman and John Mooney about the Pri-Med acquisition of Amazing Charts, Jonathan Bertman made a really interesting comment that stuck with me. I asked him how he thought that Amazing Charts would do in this world of hospitals acquiring medical practices. He said that they were evaluated the environment, but then he suggested something that I’d never heard suggested before.

He said that he was considering the idea of whether Amazing Charts could act as an ACO for its members. You could tell that this was an idea that hadn’t been fleshed out completely. Although, I found it a concept that was really interesting to consider. Could an EHR vendor act as an ACO for the doctors that use their EHR?

The key question to me is really whether an EHR vendor has enough adoption of their EHR in a given area to be able to create an ACO. I imagine an EHR vendor like MEDENT that has only focused on selling their EHR in about 5 states could have enough geographically focused EHR adoption to be able to support the ACO model.

I’ve heard a number of small practice doctors call their colleagues to action when it comes to ACOs. Their call usually includes a reminder to the days of HMO’s when they claimed that doctors weren’t part of the conversation and that they can’t let the same thing happen with ACOs. Could an EHR vendor help to bring all these small practices to the ACO bargaining table? Seems like an interesting idea worth exploring to me.

ACOs (Accountable Care Organizations)

Posted on August 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.

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.