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Healthcare IT an Important Component of New ACO Program

Posted on April 5, 2011 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.

John’s Note: The following is a guest post by Mark Segal talking about the recently announced ACO program and it’s relationship to EHR, meaningful use, and healthcare IT. I also love the insider look at rule making.

The long-awaited proposed rule on Medicare’s Shared Savings Program (SSP)/Accountable Care Organization (ACO) program is out. These 429 pages outline how the Administration plans to transform U.S. health care delivery from fee-for-service to a value-based emphasis on accountability for quality and efficiency of care provided for populations. Following a final rule later this year, the program is to start January 1, 2012, with additional January 1 annual starts by ACOs, and a special optional start possible for July 1, 2012 given the tight timing this year.

CMS solicits comments on program design areas. The final rule will certainly track the proposed rule in key aspects, but there could be important changes based on comments – although revisions must be within the scope of proposed rule options because CMS cannot add new concepts in the final rule.

Care coordination, patient centeredness and evidence-based medicine are major priorities. As expected, therefore, health information technology (HIT) and electronic health records (EHRs) will be central to ACO success.  In some cases, HIT is cited explicitly; for example at least 50 percent of ACO primary care physicians must be meaningful users of EHRs in an ACO’s second year.

In other cases, CMS, focusing on patient engagement, care coordination, and care transitions, highlights HIT capabilities an ACO should address in its SSP application. For example, CMS calls out using EHRs and health information exchange (HIE) to send care summaries at care transitions.  In addition, CMS flags HIT areas like telehealth and remote monitoring, evidence-based medicine, and measuring physician performance across practices and using measurements to improve care and service. Also, HIT will be central to the need to report on and achieve desired levels (after year one) of many of the 65 quality measures.  For example, HIT could help reduce levels of healthcare-acquired conditions.

CMS’s HIT approach is non-prescriptive.  An ACO must address, in its application, how it would address such requirements as care coordination (including use of HIT) but CMS does not dictate technology tools or specific features.   Fundamentally, CMS is outcomes-focused, looking at up-front plans and then focusing on ACO ability to meet quality metrics and overall efficiency goals.  Such flexibility contrasts with meaningful use, which is highly prescriptive.  ACOs will have flexibility to design and deploy their HIT strategies.  Overall, such flexibility should also be considered as the HIT Policy Committee, ONC and CMS consider requirements for Stage 2 of meaningful use, especially for newer areas of HIT use.

Finally, of concern, and relevant also to the need for multi-year meaningful use roadmaps, CMS reserves the right to annually change the SSP during three-year ACO agreements.  Although CMS excludes some areas from such annual changes, this uncertainty is worrisome given the substantial investments and organizational changes that must be made by ACOs.  Three years is a blink of the eye in care transformation; ACOs need regulatory stability and predictability to plan and invest with confidence and to succeed at the change management that will underlie ACO success.

So read carefully and submit timely comments!

Mark Segal is the vice president of government and industry affairs at GE Healthcare IT.

Jabba the Hutt EMR Vendor Perspective on ARRA

Posted on June 7, 2009 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 just love reading what the “Jabba the Hutt EMR Vendors” (Definition of Jabba the Hutt EMR Vendors: Good in their day, but have gotten so big and bulky that they’re barely functional) offer as a perspective on what the ARRA EMR stimulus money will do. Check out a few quotes from this article which highlight what I believe is most Jabb the Hutt EMR vendors take on the ARRA stimulus money:

“We anticipate ARRA to result in widespread adoption and use of comprehensive EHRs that support interoperability, decision support, quality reporting and clinical research,” said Justin Barnes, EHR Association Chairman and Vice President of Greenway Medical Technologies. “If we continue to work together in public and private collaboration, and build on the successes of CCHIT, HITSP and NQF, along with prudence and fiscal responsibility, we will achieve our goals of healthcare transformation and the estimated $100-$200 billion of annual savings that will come with a fully-integrated and interoperable healthcare system.”

Or Justin Barnes could have easily said that adoption would make his company millions of dollars if doctors started adopting EHR. That wouldn’t be a conflict of interest with the statement he’s making would it? Ok, I’m not saying that EHR software can’t help the healthcare industry. I think it can do some great things. However, I think the above statement lives in a far rosier world than we currently enjoy when it comes to EHR and healthcare.

Here’s another nice quote from Mark Segal, Ph.D., member of the EHR Association Government Relations Workgroup and Director of Government and Industry Relations for GE Healthcare IT (biased opinion?).

“HITECH will transform our industry and the health care system,” said Segal, “We expect a substantial increase in hospital and professional adoption of comprehensive EHRs, with most of the impact occurring over the next five years. We also expect changes in the structure of our industry and in how its products are developed, priced, and deployed.”

“As businesses, and as an Association, we are laser focused on helping our customers qualify as meaningful users,” Segal went on to say. “Even before ARRA, the Association published its interoperability roadmap and supported the development of practical, meaningful CCHIT certification criteria. We understand the dedication required to implement EHRs and want to make sure that ‘meaningful use’ criteria are achievable while moving healthcare forward, especially in such critical areas as interoperability and health information exchange.”

I do agree with Mark that how EHR products are developed priced and deployed has got to change. If it doesn’t doctors will continue to not adopt them. Let’s just not be surprised if we don’t see the “substantial increase” in EHR adoption that Mark Segal suggests. Plus, it seems like their laser focus on “meaningful use” and “CCHIT certification” misplaces what we really want to accomplish with EHR. First, “meaningful use” hasn’t been defined and second shouldn’t you have been laser focused on this goal before now?