October 2011

Final ACO Regulations Issued - What Does this Mean?

After months of anticipation, today the Department of Health and Human Services (HHS) issued final regulations governing Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program established by the Patient Protection and Affordable Care Act of 2010. This news comes after preliminary ACO regulations were unveiled in April and the Centers for Medicare and Medicaid Services (CMS) was able to collect extensive feedback from provider organizations (such as the American Medical Group Association) and other stakeholders, many of whom criticized the program for being “overly prescriptive” and involving too much risk for providers, with not enough rewards.

The much anticipated final rules lessen the burden for healthcare providers and hospitals to participate in ACOs by decreasing required performance measures, eliminating the electronic healthcare record (EHR) requirement and removing financial risks for some to participate. It also eases the timetable to participate in an ACO and offers $170 million in incentives to physician-owned and rural providers to start ACOs.

ACOs are requiring hospitals, physicians and providers to “do more with less.” The objective is to entice these caregivers to adopt a new platform of service that creates integrated networks of physicians and hospitals to collaborate with one another, thereby sharing the responsibility of caring for patients and in doing so, improve outcomes and lower costs. If requirements are not met, this means lower Medicare payments. But if goals are met, bonuses are granted, rather than a fee-for-service payment, shared across entire networks. Fortunately, the final regulations appear to make achieving the end goal more tangible than previously anticipated. Nevertheless, doctors will still need to collaborate more than ever to provide coordinated care that will result in improved quality of care, better patient outcomes and cost savings.

While the 696 paged document detailing the final rules is thorough, an appendix of proposed rules verses final rules provides a great overview, as well as an article penned by Dr. Donald M. Berwick, the administrator for CMS. For example, the final rules now require 33 measures to assess quality (rather than an initially proposed 65) in 4 domains (instead of 5):

• Patient experience

• Care coordination and patient safety

• Preventive health

• Caring for at-risk populations

Some key provisions as outlined in the final rules:

• Providers can participate in an ACO and share in Medicare savings without risk of losing money

• Fewer quality measures that ACOs must meet

• Community health centers and rural health clinics now included

• Greater flexibility in antitrust review

Bottom line: With forecasted federal savings amounting up to $940 million over four years, providers who deliver higher quality of care and effective care coordination will be able to share in more savings.

Tags: accountable care, ACOs, Berwick, CMS, healthcare IT, healthcare reform, HHS, Medicare

Posted by Shannon Murphy on October 20, 2011 at 2:20 PM
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HITSE Provides CIO Insight on Meaningful Use

What are five reasons to attend the Healthcare IT Solutions Exchange (HITSE) 2011 Conference, on October 19, at the Hilton in Dedham, Mass.?

Answer: prominent speakers, vendor solutions sessions, CIO Forum, face-to-face collaboration with peers and idea exchange.

What is HITSE? This annual event brings together hospital information system users to discuss the selection, planning, implementation and support of healthcare IT solutions. Why should you care? As you know, Meaningful Use is a hot topic across healthcare IT, and that is what HITSE’s theme will be: “Meaningful Use: Staging for Achievement.”

There will be more than 20 sessions to check out throughout the day. Here are just a few:

In the morning, Dr. John Halamka, professor of medicine at Harvard Medical School, and CIO of Beth Israel Deaconess Medical Center and Harvard Medical School, will be presenting “Beyond Meaningful Use.” Meaningful Use Stage 1 is providing hospitals and eligible professionals with goals that improve the quality, safety and efficiency of patient care. Stage 2 provides significant additional health information exchange, patient engagement and quality metrics. What's next?

Dr. Michael Blackman, vice president of Medical Affairs for McKesson’s Paragon Business Unit, will be presenting “What’s Old is New Again: Physician Adoption ion the Era of Meaningful Use.” As we know, physicians are still working through the American and Reinvestment Act’s HITECH Meaningful Use provisions. Dr. Blackman will discuss tips on how to make it easier for physicians to transition to meaningful use with healthcare professionals.

After the morning break, Anthony Guerra, founder of healthsystemCIO.com, will be presenting “How CIOs are Dealing with HITECH/Meaningful Use Mandates.” If you want to learn more about qualifying for Meaningful Use, transitioning to ICD-10, complying with evolving accountable care organization (ACO) requirements…all recent pressures on healthcare executives, this is the session for you.

What would a healthcare IT conference be without some discussions around Electronic Health Records (EHRs)? Dr. Karen Bell, chair of the Certification Commission for Health Information Technology (CCHIT) will be presenting, “EACH: Overcoming Barriers to Certifying Installed EHR Technology.” What are the hurdles in meeting the EHR certification requirements around Meaningful Use? Dr. Bell will describe the EACH™ program, designed by CCHIT, an EHR alternative certification for healthcare providers to effectively certify self-developed systems.

At the end of the day, be sure check out the CIO Forum, a panel of CIOs discussing what is and what is not working in their efforts to meet Meaningful Use objectives. This is an opportunity to interact with the panel and other members of the audience, discuss issues, ask questions and get a recap of the earlier sessions.

Still deciding if you should attend? If you are a part of the healthcare IT ecosystem, you should. HITSE is aimed toward CIOs, IT managers, department managers, IT staff, consultants and vendors.

Schwartz MSL clients who attended this conference last year were positive about the conference, noting that users and vendors work together. They liked that the conference was uniquely set up to allow vendors and hospitals to discuss the selection, planning, implementation and support of healthcare IT solutions. The partnering atmosphere allowed vendors to learn more about the challenges facing hospitals. At the same time, hospital executives could learn more about the development of solutions and tools to meet those challenges.

If you haven’t registered to attend yet, you still have time. Registration is currently open, and at an affordable rate.

If you are interested in getting more involved with healthcare IT conferences, contact Doug Russell, our Healthcare IT Practice Leader at 781-684-0770 or drussell@schwartzmsl.com.