"If beneficiary claims data are withheld, the ACO's ability to improve individual beneficiary health, as well as achieve the desired shared savings, could be compromised," the CHIME comments said. "We believe that allowing ACO patients to opt out of data sharing, while maintaining their ability to see the primary care physician participating in an ACO, contraindicates efforts to provide accountable care."
CHIME's comments cover proposed rules that would govern the capabilities of healthcare organizations to share data, and requirements that would create linkages between ACO rules, the meaningful use of EHRs, and HIE.
CHIME recommends that patients who want to opt out of sharing claims data be required to see a primary care physician not affiliated with an ACO, or that healthcare expenditures for these patients not be included for calculations to determine whether an ACO is eligible for payments for shared savings.
"Remember that patients don't have to join an ACO," said Pam McNutt, SVP and CIO at Methodist Health System in Dallas, and chair of CHIME's Policy Steering Committee. "What we're saying is that if the doctors are expected to provide high-quality care across the continuum of care, they're not going to be able to do that without patient data being entered into the ACO tools that are being used. So it just makes logical sense that if you want someone to manage care and do disease management, they need access to data outside their own practices."
CHIME also notes that the proposed ACO rule tries to encourage the meaningful use of EHRs, but it takes issue with a requirement that stipulates 50% of an ACO's primary care physicians (PCPs) meet all MU standards by the beginning of the second year of the ACO's agreement with CMS.
The letter states: "From both patient management and business perspectives, CHIME feels it would not be necessary for an ACO's PCPs to meet all MU requirements. Similarly, CHIME sees no need for CMS to specify some minimum level of EHR MU performance for the hospitals participating in an ACO."
Explains McNutt, "Since Meaningful Use regulations, in and of themselves, provide incentives and penalties, we do not think ACO regulations should add more incentives and penalties for the same goals. The biggest message here is that CMS should not try to dictate what technologies an ACO must use to achieve its goals--that also goes for telehealth and the other technologies they mention. Don't dictate what technologies we must use, but let the outcomes speak for themselves."
She added that the complexity of both programs, and the fact that both are still in the formation process, means they should not be "hardwired together."
CHIME also is concerned about the proposed use of 65 performance measures in the first year of the ACO program. "CHIME is concerned that too many measures are being proposed for the start of the Medicare Shared Savings Program, and we urge CMS to reconsider," its comments said. "CHIME also believes that CMS is underestimating the difficulty of the proposed data validation process."
CHIME recommends that CMS seek to align performance measures across similar or related programs and outline a more consistent approach for measuring quality improvement for the parts of other programs that overlap.
Finally, CHIME urges CMS to scale back expectations for the use of HIE to give healthcare organizations more time to enter HIE organizations and gain experience with the use of exchanged patient data in care delivery.
"These proposed regulations portend a level of functional health information exchange and technology adoption that may be too aggressive for deployments in January 2012 and not yet ready for effective deployment," CHIME's comments said. "We believe this issue could be better handled by allowing ACOs to determine their own technology needs, given their market and their patient population."