EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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CMS Announces $284 Million Saved in Pioneer ACO Program After Two Years

CMS Announces $284 Million Saved in Pioneer ACO Program After Two Years | EHR and Health IT Consulting |

After two years in existence, the Pioneer Accountable Care Organization (ACO) program has saved the Medicare program $384 million in total, or $300 per Medicare beneficiary per year. Participating providers saved Medicare $279.7 million in 2012 and $104.5 million in 2013. That amount of savings was announced on the website of the Department of Health and Human Services (HHS), and came via an independent evaluation report released May 4 by HHS. What’s more, as the announcement noted, the independent Office of the Actuary in the Centers for Medicare and Medicaid Services (CMS) has certified that the Pioneer ACO program is model “is the first to meet expansion to a larger population of Medicare beneficiaries.”

According to the announcement, “The independent evaluation report for CMS found that the Pioneer Accountable Care Organization (ACO) Model generated over $384 million in savings to Medicare over its first two years – an average of approximately $300 per participating beneficiary per year – while continuing to deliver high-quality patient care. The Actuary’s certification that expansion of Pioneer ACOs would reduce net Medicare spending, coupled with Secretary Sylvia Mathews Burwell’s determination that expansion would maintain or improve patient care without limiting coverage or benefits, means that HHS will consider ways to scale the Pioneer ACO Model into other Medicare programs.”

Reacting to the development, HHS Secretary Sylvia Mathews Burwell was quoted in the online announcement as saying, “This is a crucial milestone in our efforts to build a health care system that delivers better care, spends our health care dollars more wisely, and results in healthier people. The Affordable Care Act gave us powerful new tools to test better ways to improve patient care and keep communities healthier. The Pioneer ACO Model has demonstrated that patients can get high quality and coordinated care at the right time, and we can generate savings for Medicare and the health care system at large.”

The Pioneer ACO Model, one of the first payment models launched by CMS, gives experienced health care organizations accountability for quality and cost outcomes for their Medicare patients. Doctors and hospitals who form Pioneer ACOs can share in savings generated for Medicare if they work to coordinate patient care, keep patients healthy and meet certain quality performance standards, or they may be required to pay a share of any losses generated.

Currently, more than 600,000 Medicare beneficiaries are assigned to Pioneer ACO organizations.

The announcement touted the fact that Medicare beneficiaries enrolled in Pioneer ACOs, on average, “report more timely care and better communication with their providers; use inpatient hospital services less and have fewer tests and procedures;  have more follow-up visits from their providers after hospital discharge.” The announcement also noted that the Pioneer ACO program’s evolution harmonizes with broader federal efforts, including with Secretary Burwell’s goal of tying 30 percent of Medicare payments to quality and value through alternative payment models by 2016 and 50 percent to such models by 2018.

Reacting to Monday’s news, the Charlotte-based Premier Inc. released a statement, attributed to Blair Childs, senior vice president for public policy for the nationwide health alliance. “Today’s announcement proves that innovative care delivery models such as the Pioneer ACO  program are effective at generating cost savings, while simultaneously improving quality and beneficiary satisfaction with care,” Childs said. “For more than a decade, members of the Premier alliance have been national leaders implementing payment and delivery reforms that improve quality while safely reducing costs.”

Still, Premier’s Childs said in the statement that, “While we support the desire to expand the Pioneer ACO program through track 3, as described in the Medicare Shared Savings Program (MSSP) proposed rule, we believe important changes need to be made, including:

  • Strengthen the assignment process by allowing Medicare beneficiaries to attest to participation in ACOs;
  • Establish a more appropriate balance between risk and reward, including higher shared savings for high-quality providers and a period where risk can be phased in over time;
  • Modify the current benchmark methodology to mitigate the impact on ACOs that lower expenses and achieve savings, and to allow ACOs to decide how to best account for regional and local cost trends;
  • Employ a risk-adjustment methodology that truly takes into account  an individual beneficiary’s acuity;
  • Adopt payment waivers to eliminate barriers to care coordination; and
  •  Provide more comprehensive and timelier data on ACOs’ patients.”

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How Big Data Analytics Helps Accountable Care Organizations

How Big Data Analytics Helps Accountable Care Organizations | EHR and Health IT Consulting |

In an effort to revolutionize the healthcare industry and improve the quality of care, the federal government began working with physician practices to implement accountable care organizations (ACOs). ACO development and the right health IT technologies can be key in improving patient outcomes.

ACOs focus on preventing disease and emphasizing wellness among a set group of patients in an effort to reduce healthcare costs, according to The Fayetteville Observer.

“We are constantly monitored for any intervention that might keep the patient well: preventive vaccinations, fall risks at home, keeping blood pressure, diabetes, cholesterol under control,” Dr. Martin DeGraw, a family physician at New Bern’s Coastal Carolina Alliance, told the source.

Most of the practices involved in ACO development are treating Medicare patients, which is a condition under the Patient Protection and Affordable Care Act. The news source discusses an example of a woman who kept ending up in the emergency room. The woman was in a wheelchair, had no transportation available, and suffered from diabetes. She also lacked a refrigerator to store her medication.

Whenever she needed to visit a doctor and get a prescription refill, she would call an ambulance to pick her up and drive her to the emergency room. With the help of a care manager working with an ACO, this disabled woman was able to connect with a transportation provider and community nonprofit groups that built her a ramp and donated a refrigerator.

ACO development often involves implementing new technologies and integrating care across a team of healthcare professionals. The exchange of health information is integral to the functioning of an accountable care organization.

EHR technology is vital for running a successful accountable care organization. With digitized patient data available for access through EHR systems, physicians, nurses, and other healthcare professionals would be able to share information quickly and efficiently across an ACO care team.

The timely, effective exchange of big data in the healthcare industry is vital to improving patient health and integrating new models of care including ACO development. The Harvard Business Review commented on the importance of integrating data and translating data collection and analytics into practice.

One major endeavor in the healthcare industry is the need to standardize big data, as it come in many forms from images in CT scans and physician notes in EHRs to insurance claims and information from wearables and monitoring tools.

Standardization is also challenging due to the variety of entities that collect medical data – providers, payers, federal agencies, wellness institutions, genetic testing companies, public health agencies, disease-management companies, and patients themselves.

Currently, there are initiatives taking place in both the public and private sector to better integrate and standardize big data. For example, the National Institutes of Health launched a program called Big Data to Knowledge Initiative to develop better tools for collecting and analyzing healthcare information.

Predictive analytics is a key area that has used big data to improve patient health outcomes. By evaluating a person’s surroundings, better predictions can be developed and interventions can be targeted to particular patients. By preventing disease and finding ways to keep patients healthier, healthcare costs will be lowered and patient health outcomes should improve. This is essentially the mission of ACO development projects.

Practical application of new data collection systems and analytic tools is vital to the success of big data assessment. The future calls for physicians, policymakers, patients, and the entire medical team to be engaged in translating big data into practice.

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Accountable Care, Patient Portals Lag behind Expectations

Accountable Care, Patient Portals Lag behind Expectations | EHR and Health IT Consulting |

The slow uptake of accountable care reimbursement structures and the low implementation rates of advanced patient portals are among some of the top issues in healthcare over the past year, according to HIMSS Analytics, and present both challenges and opportunities for the industry as it moves forward into reforms that encourage patient engagement, individualized care, and higher quality outcomes.   While mobile technologies and telemedicine are enjoying widespread interest and use among healthcare providers, opportunities to increase adoption of health IT, improve patient engagement, and provide better patient care abound in the year to come.

“Patient engagement is more than just today’s hot topic – it is foundational to the future of healthcare,” said HIMSS Analytics Research Director Brendan FitzGerald.  Yet few providers who have patient portals have selected software that allows patients to truly engage with them, the organization found.  Sixty-two percent of hospitals are live on a portal, but just 23% can allow patient users to view their personal health record or lab results.  Without functionalities that encourage patients to visit the portal site on a regular basis or offer features that patients have expressed preference for, healthcare providers may find themselves struggling with Stage 2 meaningful use throughout 2015.

Despite the slow adoption of feature-rich portals, telehealth seems high on the agenda of many organizations.  Nearly half of organizations have adopted up to four different telehealth technologies, including two-way video conferencing, which is viewed as the best entry-level investment for providers looking to dive into the telehealth sphere.

“Organizations continue to strive toward a value-based rather than volume-based care model, and many telemedicine technologies can aid in that transition,” FitzGerald said in August. “However, the study found that organizational needs will vary based upon provider type while the numerous technologies under the telemedicine umbrella will add to the complexity of the market.  Regardless of these challenges, organizations will continue to look for and utilize technology to fill gaps and enhance initiatives in patient care.”

But adoption of those value-based principles continues to be slow for the majority of the industry.  Only a quarter of providers have a clear and defines strategy that centers on accountable care.  While the number of accountable care organizations is growing by the day, organizations may be more focused on attempting to successfully attest to Stage 2 meaningful use instead of shouldering more financial risk under a value-based reimbursement structure.

Instead, they may turn to mobile technologies as a simpler way to coordinate care, improve communication, boost efficiency, and cut waste.  “It’s one thing to state that mobile technology is cool; it’s another to determine what value it brings to the healthcare equation,” said David Collins, Senior Director, Health Information Systems for HIMSS North America.

Providers certainly see that value as increasing demands on their time make on-the-go access to EHRs, clinical decision support, and other information a necessity.  More than half of hospitals already use mobile devices such as smartphones and tablets, with 69% of providers using the technologies to access clinically-related apps.  Thirty-six percent of clinicians believe that mobile devices such as tablets and smartphones will be instrumental for reducing redundancies and improving efficiencies, which may indicate a bright future for pocket-sized computing in healthcare.

“The study found that organizational needs will vary based upon provider type while the numerous technologies under the telemedicine umbrella will add to the complexity of the market,” FitzGerald concludes.  “Regardless of these challenges, organizations will continue to look for and utilize technology to fill gaps and enhance initiatives in patient care.”

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Tech Tools to Boost Patient Collections

Tech Tools to Boost Patient Collections | EHR and Health IT Consulting |

With the proliferation of high-deductible health plans under the Affordable Care Act, patient payments have become a bigger chunk of many practices' revenue. As a result, experts say physicians should be developing more sophisticated collection strategies that take advantage of technology to help get money in the door.

Used effectively, technology can help smaller practices stay on top of patients' coverage and financial responsibilities under the new high-deductible plans, as they may be new to both practice and patient. Many newly insured patients are unaware of the service-level details of their policies. So it's important to give your staff readily available information about coverage, balances, and answers to frequently asked questions.

Technology can help you streamline processes at the front desk to facilitate collection at time of service, provided that you invest in staff training, said Colleen Fusetti, a director at FluidEdge Consulting in Malvern, Pa.

"You need to put a lot of emphasis on training staff to use the technology and understand patient balances and payment options so that they, in turn, can educate the patient," she said. "The ability to collect drops considerably after the patient walks away from the front desk."

Fusetti and other revenue cycle management experts also offered these tips for getting the most out of your technology tools to improve patient collections:

• Set up a patient portal. The portal allows patients to check their eligibility and claims data and view or pay their balances online.

• Integrate an insurance eligibility service into your practice management and EHR systems. Some services allow you to run a verification check on every patient scheduled for a visit over the next few days so that you can reach out to patients in advance to get new insurance information, if needed.

• Use an automated appointment reminder service. The services not only remind patients about upcoming appointments but also link patients to the portal where they can see any pending balances, make payments, and review their coverage before arriving.

• Consider online credit card processing. You can accept credit or debit card payments from any Internet-enabled device linked to a mobile card swiper.

• Set up automatic payments. Many merchant service companies offer an option to keep patients' credit card information on file securely. After discussing financial responsibility for a future procedure or service, patients can decide whether to authorize a one-time payment pending final calculation of their bill or set up a payment plan with recurring payments.

• Take advantage of online resources. The AMA offers a Point-of-Care Pricing Toolkit free to its members. The resource provides tools to help practices collect what patients owe at the time of service.

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Accountable Care, EHR Interoperability Vital for DOD Healthcare.

Accountable Care, EHR Interoperability Vital for DOD Healthcare. | EHR and Health IT Consulting |

Adopting an EHR infrastructure based on open-source technologies and embracing the private industry’s enthusiasm for accountable care will be critical for the Department of Defense if it wishes to continue providing cost-effective, quality care for military personnel, according to a new report by the Center for a New American Security.

The brief, written by Dr. Peter Levin, Retired Army General H. Hugh Shelton, and Dr. Stephen Ondra, asserts that nimble health IT infrastructure and an emphasis on value-based care is the only way the DOD can break its “unsustainable spiral” of rising fee-for-service costs inflated by a decade and a half of continuous military action overseas.

The inflated expenses of traditional fee-for-service care affect the military health system in the same way as they impact private industry, causing the DOD to spend 10% of its base budget on healthcare costs, up from 6% in 2000.  “The core problem is that TRICARE’s fee-for-service approach is subject to the same perverse incentive structures that have driven up healthcare costs in the United States by explicitly connecting payment to volume of care, not value of care,” the report says.

High levels of contracted care, a growing retiree population, and the unique requirements of maintaining a deployment-ready cadre of healthcare professionals working in challenging care sites around the globe have driven up spending to untenable levels.  “Bold steps must be taken to bring the costs of DOD provided healthcare coverage under control, while keeping the nation’s promise to those who serve, retirees and their families,” the brief states. “DOD leadership should… seize the opportunity to build upon the framework already launched by the Centers for Medicare and Medicaid Services (CMS) and many private sector payers.”

Modernizing the DOD’s health IT infrastructure it a crucial step for achieving cost-cutting reforms, but the well-documented history of failure after failure to bring an innovative and interoperable EHR into play has frustrated the report’s authors and industry onlookers alike.

“The corroding effects of institutional inertia and resistance to change any aspect of DOD’s healthcare procurement are acute and plainly visible. A prime example of obstruction is the tortured history of DOD’s electronic health record (EHR),” the authors say.

The DOD’s $4 billion Armed Forces Health Longitudinal Technology Application (AHLTA) system, in place since 2005, “has been pilloried by DOD’s own doctors and nurses as inefficient and poorly designed.  It is not integrated to – nor can it seamlessly share data with – other health record systems, including the VA’s EHR system, which serves an important and overlapping population alongside DOD, and for which the seamless transfer of health information would greatly assist in health care and service-related benefits delivery.”

The DOD is currently undertaking a lengthy and expensive procurement process for a new infrastructure with a focus on EHR interoperability, with a number of prominent vendors vying to win the $11 billion contract.  But standard commercial software geared towards traditional hospitals and health systems won’t do the trick for the military’s sprawling obligations, the report says.

“Given the fast pace of technology changes, we hope that DOD will not repeat the mistaken multi-billion dollar decision that will hold it captive to the innovations of any single company or the services of a solitary vendor. Because of how enterprise systems are deployed, a poor selection at the first stage will inexorably lower performance and restrict enhancement choices for more than a decade. Alternatively, the DOD could choose a platform that is extensible, flexible and easy to safely modify and upgrade as technology improves and interoperability demands evolve.”

“We are concerned that a process that chooses a single commercial ‘winner’, closed and proprietary, will inevitably lead to vendor lock and health data isolation,” the authors add.

Of the teams currently in contention for the prize, only PricewaterhouseCooper, which recently added Google as a partner, is offering a system founded primarily on open-source principles.  Yet all of the companies hoping to secure the contract, including Cerner Corporation, Leidos, and Accenture, Allscripts and Hewlett-Packard, and Epic and IBM, have a history of innovation in the enterprise health IT market, and have long experience with EHR interoperability and large-scale deployments.

The DOD is taking its time to announce which collaboration will be working on its EHR modernization over the next decade, but that might not be a bad thing.  Making the right choice for the long-term contract will be an important step towards ensuring that much-needed reforms, both technical and financial, are rolled out appropriately to meet the needs of one of the biggest healthcare systems in the world.

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Accountable Care Improves Patient Safety by 17% Since 2010 |

Accountable Care Improves Patient Safety by 17% Since 2010 | | EHR and Health IT Consulting |
Adverse patient safety events and preventable hospital deaths have dropped significantly thanks to accountable care measures and other quality improvements.
Accountable care measures that pin financial reimbursements to patient outcomes are partly responsible for a significant decline in the number of patient safety events and hospital-acquired conditions (HACs) that lead to deaths, the Department of Health and Human Services announced today.  The report shows a 17 percent decline in preventable mortality between 2010 and 2013, equating to 50,000 fewer deaths, 1.3 million fewer hospital-acquired conditions, and approximately $12 billion in savings.
“Today’s results are welcome news for patients and their families,” said HHS Secretary Sylvia M. Burwell. “These data represent significant progress in improving the quality of care that patients receive while spending our health care dollars more wisely.  HHS will work with partners across the country to continue to build on this progress.”
“Never before have we been able to bring so many hospitals, clinicians and experts together to share in a common goal – improving patient care,” added Rich Umbdenstock, President and CEO of the American Hospital Association. “We have built an ‘infrastructure of improvement’ that will aid hospitals and the health care field for years to come and has spurred the results you see today. We applaud HHS for having the vision to support these efforts and look forward to our continued partnership to keep patients safe and healthy.”
A strong focus on improving patient safety through the implementation of health IT infrastructure, including EHRs, clinical decision support, and predictive analytics, has worked alongside policy and reimbursement reforms to make hospital stays less risky.  HHS has partnered with a number of stakeholders, including the Agency for Healthcare Quality and Research (AHRQ) to drive improvements and reinforce a culture of care.
“AHRQ has developed the evidence base and many of the tools that hospitals have used to achieve this dramatic decline in patient harms,” said AHRQ director Richard Kronick, PhD. “Additionally, AHRQ’s work in measuring adverse events, performed as part of the Partnership for Patients, made it possible to track the rate of change in these harms nationwide and chart the progress being made.”
Nearly half of the decline in the national HAC rate took place over just one year, says AHRQ in its report, from 2012 to 2013.  Within that time, hospitals reduced the number of HACs by 9 percent.  Around 40% of the reductions came from fewer adverse drug events (ADEs), while a dip in the number of pressure ulcers made up 20% of the improvements and fewer catheter-associated urinary tract infections were responsible for 14% of the progress.  Other HACs reduced since 2010 include falls, surgical site infections, and ventilator-associated pneumonia.
While AHRQ acknowledges that there is still a great deal of work to be done in order to make patient safety within the hospital a given, the report calls the progress a “remarkable achievement” and praises hospitals for their commitment.  The organization provides a number of tools and guidelines to healthcare providers that can help develop safety programs and continue the reduction in adverse events that still claim patient lives.

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