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11/2/2011
04:49 PM
Paul Cerrato
Paul Cerrato
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Obsession With Meaningful Use Could Backfire

Don't let your push to obtain the government's EHR financial incentives blind you to the next big hurdle: accountable care.

"Meaningful Use should not be seen as a financial incentive, but rather as a milestone that helps define a successful EHR [electronic health record] implementation." Those words of wisdom from Ferdinand Velasco, MD, the chief medical information officer (CMIO) at Texas Health Resources in Arlington, Texas, bring to mind an even more pressing issue: MU isn't the end of the story, only the beginning. And if an IT team is obsessed with meeting the letter of the law, they may ignore its spirit. Such shortsightedness will mean you'll be ill-prepared for the much bigger initiative about to hit the streets--namely, accountable care organizations (ACOs).

While the goal of ACOs is to improve clinical outcomes and reduce costs, it's hard to know at this early stage whether they'll accomplish that feat. But when the former head of the agency that oversees the Medicare and Medicaid programs raises doubts about their financial viability, one has to worry.

Gail Wilensky, the former administrator of the Health Care Financing Administration, recently reviewed the results of the Physician Group Practice Demonstration Project, which is supposed to serve as a model for ACOs. While the project showed that large group practices met quality standards designed to improve patient care, the practices had a much harder time reaching their financial goals.

[Which healthcare organizations came out ahead in the InformationWeek 500 competition? See 10 Healthcare IT Innovators: InformationWeek 500.]

In Wilensky's words: "Even with all their experience, only two of the [Physician Group Practice] participants were able to exceed a 2% savings threshold the first year of the demo and only half managed to surpass that threshold after three years." While there are all sorts of variables to take into account here, the bottom line is obvious: If the big boys--including practices affiliated with the University of Michigan and Dartmouth--can't get this right, how are the rest of the nation's practitioners going to make accountable care happen?

Nonetheless, if your hospital or practice wants to work within the Medicare/Medicaid system, you'll have to play by the new rules. The long-awaited final regs for ACOs were recently published, containing 33 quality measures, half of what an earlier proposal called for. The rules are divided into four domains: patient/caregiver experience; care coordination and patient safety; preventive health; and caring for at-risk populations. According to Centers for Medicare and Medicaid Services (CMS) administrator Donald M. Berwick, the idea is to "create a more feasible and attractive onramp for a diverse set of providers and organizations to participate as ACOs."

The ACO initiative is part of a plan known as the Medicare Shared Savings Program. And while it doesn't demand EHR implementation, the program does require healthcare providers to collect and share data. One of the best ways to collect that data, of course, is via EHRs. In fact, the final rules state that "ACOs, ACO participants, and ACO providers/suppliers are encouraged to develop a robust EHR infrastructure."

So yes, meeting the MU requirements will help you qualify as an ACO, but if you reach only the bare minimums outlined in the MU rulebook, that won't be enough. The ACO standards require more than the minimum.

And then there's that other issue that healthcare organizations don't like to talk about: false attestation. Currently, it doesn't appear as though CMS will make a vigorous effort to audit practices or hospitals that say they have met all the MU requirements.

Jonathan Bush, the CEO of Athenahealth, told InformationWeek Healthcare that it's his understanding CMS will audit a practice only in reaction to a complaint. "Who would complain that a doctor attested inappropriately? No one, so no one will be audited."

Looks like a perfect storm to me: Providers attesting to quality improvements they've never made to obtain financial incentives they don't deserve, in preparation for an even larger healthcare initiative--ACOs--that may or may not reduce America's obscenely high medical tab.

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MedicalQuack
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MedicalQuack,
User Rank: Moderator
11/3/2011 | 11:31:11 PM
re: Obsession With Meaningful Use Could Backfire
Well you might want to add on the GE Centricity issue needing a software update before they can attest.

http://ducknetweb.blogspot.com...

Sadly we have too many folks at HHS and at the ONC who have never written a stick of code to understand all the processes and mechanics and thus we get deadlines that make CIOs nuts. Also fair to recognize that technology in the last couple years has moved up to rocket speeds too so add that to executive figure heads who never wrote a stick of code and you have some good, but lost people as there's no substitute for hands on knowledge.

A bit of satire here, but what do you expect from the ONC when you have HHS sponsoring a Facebook contest for an app to use for a disaster. Well do you consider riots a disaster...I would not applicable and an act of Congress may follow to spell out exactly what their app may really be able to do, not to mention a tiny bit of privacy here:) Again, the lack of hands on coding somewhere along the line makes for more errors and just unrealistic deadlines.

You have Todd Park over there who has done some great things with websites and data and nothing wrong with that at all but he came from outside of government and we miss the meshing of business ethics with the government needs, so little off balance there. Blumenthal picked his exit at the right time as things were changing fast.

Heck I have been trying to pry a few from the ONC to talk about their own PHR or other consumer IT use, but no luck as we seem stuck on "its for those guys over there" and they don't share so again do they participate as consumers? It would really be nice to hear and that would do wonders for consumers. Every time they venture over into the consumer side I call it "magpie healthcare" because I never see anything to where they take a few moments and step into the consumer shoes but rather cling tight to the "expert" titles that maybe too many of use today think is important.

http://ducknetweb.blogspot.com...

So let's come back around to an ACO and involving the consumer...duh...kind of hard as an ACO is not a rigid structured program and rules get written as you go along. More important to me though is the care I get and the less hoops my doctor has to jump through and not spend an undue amount of time on administration, the happier I am. I spoke this year at the e-MDs annual meeting and they really did a great job with educating attendees and knocking themselves out to help. e-MDs was started by and is still run by doctors so they get it as they are big but not under the corporate umbrellas we see today. e-MDs actually was the first vendor who attested and their MDs received their incentives too.

We all know we need to save money and start an ACO of some sort, but whether or not it all falls into place as designed remains to be seen. Again, some folks in executive positions that have written a stick of code would really help as now Ms. Sebelius has to rely on HealthIT information from those folks and can't make her own decisions without consulting and I think the same goes for most of the ONC folks. This is just the way of the world anymore and not directed at anyone in particular.
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