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Hospital CIOs Scrutinize ACO Rule

April 14, 2011
by David Raths
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More IT leaders weigh in with both enthusiasm and concerns about proposed rule

As healthcare organizations begin an in-depth study of the proposed rule for accountable care organizations unveiled by the Centers for Medicare & Medicaid Services on March 31, their CIOs are getting a better understanding of the impact on IT organizations and preparing responses. (The 60-day comment period for physicians and other interested parties ends June 6, 2011.)

Many observers have noted that, as with the proposed meaningful use rule last year, the bar seems to be set quite high and that may limit the number of organizations in the Shared Savings program. For instance, there are 65 proposed quality measures to report on and very specific provisions for how patients can opt out of sharing their Medicare data with the ACO.

Linda Reed, R.N., who is vice president and CIO of three-hospital Atlantic Health in Morris Plains, N.J., says her organization is working on several fronts to understand the proposed rules and craft a response. “As with meaningful use, we hope the comment period will adjust some items and provide clarity for moving forward,” she says.

“We are still reviewing the detail, but we were surprised at some of the items, including that at least 50 percent of an ACO’s primary care physicians must be meaningful users by the start of the second year,” Reed says.

Given where a number of physicians are in the EMR journey, this may be difficult to achieve, she adds. Depending on how an ACO is composed, that requirement may force some organizations to shift resources toward getting individuals up to speed. “Data exchange will also be a big component in ACO effectiveness, whether at an organizational or HIE level,” she says.

Mary Anne Leach, vice president and CIO of the Children’s Hospital in Denver, says she plans to closely study the proposed rule and provide comments to CMS. But she has already started planning how her organization’s formation of an ACO will impact IT operations. The Children’s Hospital is in the early stages of developing an ACO with a large physician network in Colorado, she says. “We think enterprise analytics capability will be key,” she says, “so our work on a data warehouse, dashboards, and registries for population health will all be components of a successful ACO.”

A second area that will become more important, she believes, is telemedicine. Part of managing population health will include monitoring people in their homes and using telemedicine to reach providers and patients in rural parts of the state, Leach explains. “There are huge cost savings and health improvements possible through telemedicine in areas where there are scarce provider resources, and I think telemedicine is finally getting some traction.”

Finally, she says, using the Stark exception, Children’s has helped 60 providers with Epic (the Madison, Wis.-based Epic Systems Corporation) electronic health record deployment and that has had a huge benefit in getting providers sharing documents even before a fully functional health information exchange develops in Colorado. That interoperability will be helpful in care coordination as the ACO develops, she says.

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