Health IT executives may get a feeling of déjà vu when reading through the 429-page proposed rule for accountable care organizations unveiled by the Centers for Medicare & Medicaid Services (CMS) on March 31.
That’s because the ACO rule is not only similar in flavor to last year’s meaningful use rule, it also invokes the HITECH Act and EHR incentives in several instances. For instance, on page 197, CMS states: “We plan to continually align the ACO reporting requirements with those required for the EHR Incentive Program and leverage the infrastructure and measures specifications being developed for that program.”
Some of the document’s proposals regarding risk, antitrust provisions, governance and marketing rules may be of less keen interest to CIOs.But the section detailing the 65 proposed quality measures and how they would be reported should be critical reading for CIOs.
In the first year, the proposal relies on quality measures derived from existing CMS programs, including the EHR incentive program. But the agency notes that it expects to expand the ACO measures and reporting mechanisms to include those that are directly EHR-based. “Specifically, we expect to expand the measures through future rulemaking to include other highly prevalent conditions and areas of interest, such as frailty, as well as measures of caregiver experience,” the rule states. “In addition to ambulatory measures, we would expect to add measures of hospital-based care and quality measures for care furnished in other settings, such as home health services and nursing homes.”
The GPRO Tool
CMS says a new Web-based reporting tool could ease the administrative burden of clinical quality reporting for ACOs.
In 2010, 36 large group practices and integrated delivery systems used the group practice reporting option (GPRO) tool to report 26 quality measures for an assigned patient population under the Physician Quality Reporting System. The GPRO tool allows for reporting to CMS of beneficiary laboratory results and other measures requiring clinical information. The tool would allow ACOs to submit clinical information from EHRs, registries, and administrative data sources required for measurement reporting. CMS says the tool reduces the administrative burden on healthcare providers participating in ACOs by allowing them to tap into their existing IT tools that support data collection and healthcare provider feedback, including at the point of care.
Noting that at least 50 percent of an ACO's primary care physicians must be “meaningful EHR users” by the start of the second Shared Savings Program performance year, CMS intends to develop the GPRO Web-based tool to interface with EHRs so that the EHR data could directly populate the ACO GPRO tool with the required quality data.
CMS proposes that the existing GPRO tool be built out, refined, and upgraded to support clinical data collection and measurement reporting and feedback to ACOs under the Shared Savings Program.