As HHS proposes new rules on accountable care, IT vendors may need to adjust their health care IT portfolios to cash in on the shared savings program.
With HHS (the Department of Health & Human Services) announcing
its Medicare incentive program for ACOs (accountable care organizations), IT
vendors will need to modify their health care platforms to take advantage of
the potential savings.
ACOs are groups of health care companies that join together to
coordinate care for Medicare patients and
earn incentives based on positive outcomes, such as longevity of life,
or whether a condition such as diabetes or hypertension has been
contained.
The
Medicare Shared Savings Program proposes new rules on how health care organizations-whether they're a doctor's office, hospital,
laboratory, supplier or long-term care facility-can be accountable for quality of care and share data on patients' treatment.
Under the proposal announced on March 31, HHS will offer incentives
to providers in ACOs that meet quality-of-care goals. Incentives for
ACOs would be linked with the meaningful use incentives for EHRs
(electronic
health records).
The ACO incentive program will present new challenges for IT as far
as retooling EHR and HIE (health information
exchange) platforms. Applications will need to be able to identify,
produce, calculate and distribute shared savings among providers in an
ACO, according to
Shahid Shah, CEO of IT consulting firm Netspective Communications and
author of the
Healthcare IT Guy blog.
"The IT required for meaningful use is a quite different from what
is required for ACOs and will be nowhere as easy for
existing legacy EHRs to simply retool their current platforms like they
could for meaningful use," Shah told eWEEK. "Getting data out across
disparate systems is going to be a problem."
The ACO rule could also bring some difficulties for IT vendors regarding telehealth technology, John Moore, managing partner for
Chilmark Research, wrote in an e-mail to eWEEK.
"The Medicare Shared Savings Program encourages the use of
telehealth and remote monitoring, and most EHRs are not well equipped
to
accept this data," he said.
With physicians sharing both clinical and administrative data,
they'll be able to avoid unnecessary repetition of expensive
procedures, Shah
said.
The government pays incentives if ACOs are able to keep costs in
check, but unlike the government's meaningful use guidelines on EHRs,
no penalties result from not following HHS' ACO guidelines, Shah noted.
The ACO incentives are provided for under the Affordable Care Act President Obama signed on March 23, 2010.
"Section 3022 of the Affordable Care Act requires CMS (the Centers
for Medicare & Medicaid Services) to establish a shared savings
program to facilitate coordination and cooperation among providers to
improve the quality of care for Medicare fee-for-service beneficiaries
and reduce
unnecessary costs," CMS reports.
"The Affordable Care Act is putting patients and their doctors in
control of their health care," HHS Secretary Kathleen Sebelius
said in a statement. "Accountable care organizations will improve
coordination and communication among doctors and hospitals, improve the
quality
of the care their patients receive and help lower costs."
CMS is seeking public comments on the rule, before it takes effect
on Jan. 1, 2012. The agency will hold open forums to help the public
understand how ACOs operate. Health care providers forming an ACO must
meet quality
standards in five areas: patient/caregiver care experiences, care
coordination, patient safety, preventive health and at-risk
population/frail elderly health.
In a related development, on March 21 HHS announced its National
Quality Strategy to coordinate health care initiatives between the
public and private sector. HHS outlined the use of EHRs as a way for
the health care industry to measure quality.
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