Final ACO rule holds great possibilities for health IT


Compared with the draft rule on accountable care organizations (ACOs) that the Centers for Medicare & Medicaid Services (CMS) issued last March, the final rule has made it significantly easier for ACOs to qualify for the Medicare shared savings program in the area of health IT. What CMS has done, in effect, is to recognize that healthcare organizations are in a variety of stages on their road to electronic perfection. Yet that doesn't mean that the less technologically advanced groups aren't trying to provide accountable care that lowers costs and raises quality.

Here are some of the provisions in the final rule that lower the bar for participation and will help ACOs succeed:

  • In the draft regulation, 50 percent of the primary care physicians in an ACO had to show Meaningful Use of an electronic health record (EHR) by the beginning of the second year of the shared-savings program. That requirement has been eliminated, although the achievement of Meaningful Use now is a heavily weighted quality measure.
  • The number of quality measures has been reduced from 65 to 33. Moreover, data on various metrics may be reported through a combination of methods, including surveys, claims data, and the new group-practice-reporting-option (GPRO) web interface that was piloted in the Physician Quality Reporting System (PQRS). The GPRO tool allows groups to report lab results, as well as clinical information from EHRs, registries, administrative data sources and paper records.
  • All of the preventive and chronic care metrics for ACOs are included in the list of quality measures for Stage 1 of Meaningful Use, making it simpler to collect and submit the ACO data.
  • ACOs no longer have to use patient registries, although it is expected that most of them eventually will, because of their value in population health management.
  • Under a new Advance Payment ACO Model, some organizations will receive their anticipated share of savings up front instead of having to wait until their claims are analyzed after the first year. This will provide some ACOs with funds to help build their IT infrastructure.

As the laudatory comments from the American Medical Association and some other industry groups show, the ACO final rule is a much kinder and friendlier creature than its progenitor was. Time will tell, however, whether the overall project can generate a significant return on providers' investments in the necessary infrastructure.

While many healthcare systems are already moving toward accountable care--prodded by private insurers, in some cases--it's still unclear whether this approach will cut cost growth. But if payers are determined to move toward an upside and downside risk approach--as CMS now has said it will do after the first three-year program--then most providers may have no choice but to become part of ACOs.

To the extent that this prediction comes true, the health IT industry will benefit in ways that go far beyond the stimulus provided by Meaningful Use. Successful ACOs will need not only EHRs and connectivity between hospitals and ambulatory care providers, but also a host of other electronic links that extend across all care settings. Vendors will have to rewrite their software to encompass patient registries, non-visit care management, and predictive modeling. And providers will have to begin taking advantage of the multitude of possibilities in secure online messaging, telemedicine and mobile health applications.

It's an exciting time to be involved in health IT. - Ken

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