The health IT impact of the ACO rule: Is the glass half-empty or half-full?

The government's proposed rule for accountable care organizations (ACOs) could accelerate the adoption of higher-functioning electronic health records (EHRs), other health IT tools, and health information exchanges. But if the criteria for ACOs that are eligible to participate in Medicare's shared savings program are retained in the final rule, they may prove too difficult for most organizations to meet in the near term. In that case, the health IT impact of the ACO regs might prove to be less than appears on the surface.

Take the requirement that half of the primary care doctors in ACOs must show meaningful use of qualified EHRs. Even in stage 1 of Meaningful Use, "that's not going to happen," predicts Bruce Merlin Fried, a healthcare attorney with SNR Denton in Washington, D.C., and a veteran health IT commentator.

Some large healthcare organizations employ a lot of primary care doctors and have given them qualified EHRs. Couldn't they meet this requirement? "If the objective of the ACO regulations is only to have large, well-developed, well-capitalized, highly sophisticated organizations be ACOs, sure, that's possible," Fried tells FierceHealthIT. "But if the government is going to try to encourage the development of ACOs in parts of the country where there aren't such large enterprises, I think that will be a barrier to ACO development."

Partly because of the cost of health IT, the creation of ACOs that meet all of the complex regulations will be very capital-intensive, Fried points out. The government's estimate that the average ACO will spend $1.75 million to start up and operate for the first year, he adds, is "woefully inadequate." And it will take some time before ACOs are capable of generating enough savings to see a return on that investment, he notes.

Scott Weingarten, MD, CEO of Zynx Health, which makes clinical decision support software, sees the proposed ACO rule in a different light. "My perspective is that the government ACO regulations as they relate to information technology for evidence-based medicine are measured and reasonable," he says.

The rule's strong emphasis on clinical decision support and the use of evidence-based guidelines, Weingarten says, will "enable providers and patients to benefit from new advances that could lead to better patient care."

A recent article in Health Data Management notes that the ACO proposal requires health IT capabilities that go well beyond the stage 1 requirements for Meaningful Use. Besides advanced decision support, the rule's care coordination goals may require providers to use predictive modeling of patient health risks, telemedicine, comparative benchmarking, and the exchange of clinical summaries both within and outside the ACO during transitions of care. There are also a number of criteria relating to data exchange with Medicare patients, including treatment reminders and advice about managing one's health.

Weingarten agrees that the ACO rule "is more advanced than stage 1" of Meaningful Use. He sees "some consistency" between the health IT requirements for ACOs and what has been discussed as possible criteria for stages 2 and 3 of meaningful use.

However, the Medicare shared savings program for ACOs starts in 2012, the second year in which providers can show Meaningful Use by meeting stage 1 criteria; stage 2 doesn't begin until 2013. Does this imply that the government is looking for ACOs to accelerate their use of health IT so they can participate in the shared savings program?

"Many organizations are going to have to work hard in order to implement evidence-based clinical decision support," replies Weingarten. "But if you look at what's being called for -- forgetting the timing for one second -- it's what will lead to improved quality and cost outcomes, which will be required to succeed as an ACO."

Weingarten adds that health IT vendors will develop the necessary capabilities if their customers demand them. - Ken

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