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Reactions to final ACO rule

As you probably heard, CMS today released a 696-page final rule on accountable care organizations. I wrote a piece for InformationWeek Healthcare that should be posted no later than tomorrow morning, so I’m not going to rehash that. What I will do is show you the various reactions from many interest groups to the rule, particularly the ones that have an IT bent. Unfortunately, there haven’t been too many released so far, and none from the major health IT associations. Now, AMIA and CHIME are gearing up for their annual conferences next week and, let’s face it, the rule is 696 pages long, so I’ll update this page as statements come in.

For the official line, see CMS Admnistrator Don Berwick’s commentary in the New England Journal of Medicine. Notably, he mentions EHRs in the very first paragraph, in which he explains how he delivered accountable care as a Harvard pediatrician.

From the private sector, the American Hospital Association liked the flexibility in the final rule, as evidenced by this statement:

STATEMENT ON FINAL ACO RULE

Rich Umbdenstock
President and CEO
American Hospital Association
October 20, 2011

Today’s rules represent the direction in which the hospital field is moving – toward better coordinated patient care across care settings. We commend CMS for listening to the concerns of America’s hospitals. The hospital field is actively working on ways to improve care delivery and the final accountable care organization rule provides hospitals a better path to do so.

In response to the concerns of the AHA and its hospital members, CMS made significant changes to the financial model, provided more flexibility in the assignment of beneficiaries and took a second look at the quality framework. We believe today’s menu of ACO options allows America’s hospitals to create new models of accountable care organizations on which the transformation of health care delivery is so dependent.

The AHA is also encouraged by the historic effort among several federal agencies to achieve the goal of better coordinated care. Specifically the antitrust agencies responded to hospital concerns and reversed their plan to require antitrust preapproval for every ACO applicant and instead provided guidance. We believe removing this barrier was essential to encouraging ACO participation.

Hospital and health system leaders welcome the concept of providing patient care in a more accountable, more coordinated way and know that they will be held increasingly at financial risk in improving outcomes for patients and becoming more efficient in the delivery of services. Hospitals already are engaged in private sector ACO initiatives and the final rule provides an additional avenue for the provision of accountable care.

The AHA strongly supports the goals and principles of the ACO program and delivery system reforms that improve patient care and quality while reducing costs. We will continue to work with CMS and other agencies to remove the substantial legal and regulatory barriers throughout the health care system to clinical integration that still remain.

I understand the American Medical Association had similar impressions, but I haven’t actually seen the AMA’s statement yet. However, the Advanced Medical Technology Association (AdvaMed), which stands to lose if expensive diagnostic tests are reduced, was disappointed:

AdvaMed Statement on

Final Accountable Care Organization Regulation

WASHINGTON , D.C. Ann-Marie Lynch, executive vice president of the Advanced Medical Technology Association (AdvaMed), released the following statement regarding the Centers for Medicare and Medicaid Services (CMS) final rule on Accountable Care Organizations (ACOs):

“AdvaMed is concerned that CMS failed to address key issues in the final ACO rule that would have advanced patient care, ensured patient access to innovative treatments and technologies, and avoided incentives to stint on care.

“We are also concerned the rule does not address the very real danger of slowing the development of new treatments and cures. The failure to consider how innovative products play an important role in improving patient care threatens medical progress for current and future patients. Without certain design elements, the ACO program may have the effect of limiting treatment options and discouraging physicians from adopting new advancements in care.

“CMS failed to include or even discuss common-sense provisions to support continued medical progress, despite concerns expressed by the life science industry, patient groups, and members of Congress. CMS’ action runs counter to the President’s January 18 Executive Order directing agencies issuing regulations to seek to identify ways to promote innovation and undercuts the President’s goal of fostering a ‘national bioeconomy.’

“We are also disappointed that CMS rolled back rather than revamped the quality measures included in the draft rule. The final rule lacks sufficient measures of patient outcomes to assure quality of care. There are large areas of clinical practice not addressed at all – including cancer, severe arthritis, chronic pain and osteoporosis.

“This rule is a missed opportunity to ensure that the sweeping changes in payment policy established by the Affordable Care Act will support medical progress and assure that patients can receive the care most appropriate for their needs.”

The Association of American Medical Colleges was thrilled that med schools won’t be held to the same standards as everyone else:

AAMC Applauds Final ACO Rule Excluding Medical Education Payments

Washington, October 20, 2011AAMC (Association of American Medical Colleges) President and CEO Darrell G. Kirch, M.D., issued the following statement today on the Medicare Shared Savings Program “Accountable Care Organizations”(ACO) Final Rule:

“The AAMC is pleased that the ACO final rule excludes indirect medical education payments from the methodology used to assess shared savings under the program.  By not including these policy payments in the historical cost analysis, medical schools and teaching hospitals— institutions that often treat the sickest and most vulnerable patients—have a better opportunity to participate in the ACO initiative.

While we are still examining the details of the final rule, the AAMC has always been supportive of new models of care that put patients first and also leverage the benefits of institutions’ educational and research missions to reign in the unsustainable growth in health care costs.  We look forward to working with our members, the Center for Medicare and Medicaid Innovation, and the Centers for Medicare and Medicaid Services to help identify ways to partner with the academic medicine community and institutions working to advance meaningful health system innovation.”

The Campaign for Better Care, a coalition of consumer groups interested in quality care for seniors, called the rule a “reasonable compromise”:

Consumer Groups Say New Accountable Care Organization Rule is a  Reasonable Compromise, Urge All Parties to Get On-Board to Ensure Patients Will Soon Benefit from Better Coordinated,  More Patient-Centered Care

Statement of Campaign for Better Care Leader Debra L. Ness

“The final rule on Accountable Care Organizations (ACOs), released by the U.S. Department of Health and Human Services today, has provisions that will both please and concern various parties.  As advocates for consumers, particularly for our oldest and sickest patients who urgently need better-coordinated care, we applaud this effort to incentivize better primary care, increase coordination, and share accountability across providers.  We are very pleased that this final rule will require ACOs to adhere to strong patient-centered criteria, use beneficiary experience of care measures to evaluate performance, and ensure full transparency, notification and choice for beneficiaries.  These provisions are all essential to realizing the promise of successful ACOs, which patients in this country are counting on.

This new rule is not perfect, but it provides a path away from the broken, dysfunctional health care system we have today toward a system that offers higher quality, better coordinated and more patient-centered care.

We consider it most unfortunate that the provisions requiring beneficiary participation on ACO boards have been tempered.  We urge the Department to closely monitor these provisions to ensure that consumers and beneficiaries are engaged in the design, governance and assessment of ACOs in their communities.  We will be watching closely to assess whether ACOs operate in the public interest and reflect the needs and perspectives of the communities they serve.  Consumers and patients hope and expect that these provisions will be strengthened down the road if needed.

In the end, we see this rule as a reasonable compromise.  The Department was enormously responsive to the comments that were filed and in particular, to concerns raised by providers.  It is time now for all parties to come together to create successful ACOs that deliver care that is truly patient-centered, that improves quality and care coordination, and that lowers costs.  This new model of care deserves to be tested along with the numerous other innovations that have and will be promoted by the CMS Innovation Center.  Patients and consumers have no time to waste.

The stakes are too high to ignore the promise that ACOs offer to improve care and bring us better value for our health care dollars.  We must not let opponents of reform use any remaining differences to block the progress Americans so urgently need.  Transformation is never easy, but the cost of failure to patients, families and the country is simply too high.”

AARP called the rule a “good first step” in improving quality and lowering Medicare costs:

AARP Statement on New HHS Programs Designed to Improve Coordination and Quality of Patient Care in Medicare

WASHINGTON—AARP Legislative Policy Director David Certner released a statement following today’s announcement that the Department of Health and Human Services (HHS) has issued a final rule introducing two new programs—the Medicare Shared Savings Program and the Advance Payment model—to help providers better coordinate patient care and use health care dollars more wisely through accountable care organizations (ACOs). Both programs create incentives for health care providers to work together to treat an individual patient across care settings – including doctors’ offices, hospitals, and long-term care facilities. Certner’s statement follows:

“Accountable care organizations have the potential to improve the quality and lower the cost of health care for all patients. By working across the spectrum of providers to ensure that patients get the right care at the right time and in the right setting, accountable care organizations have shown great promise in positively changing the way we deliver care.

“The programs announced today can benefit people in Medicare by encouraging providers to work together to better coordinate patient care, which can lead to fewer hospital readmissions and lower Medicare costs. AARP believes today’s announcement is a good first step and we welcome the chance to further review these programs.”

 

October 20, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Here’s the rule for meaningful use

Here’s the CMS proposal for meaningful use: http://www.federalregister.gov/OFRUpload/OFRData/2009-31217_PI.pdf

There is a companion interim final rule related to standards and certification: http://www.federalregister.gov/OFRUpload/OFRData/2009-31216_PI.pdf

There’s a public conference call at 5:15 p.m. EST.
From ONC:

On Wednesday, Dec. 30, 2009, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) will announce two regulations that lay a foundation for improving quality, efficiency, and safety through meaningful use of electronic health record (EHR) technology.

The regulations will help implement the EHR incentive programs enacted under the Health Information Technology for Clinical and Economic Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act of 2009. Public comments on both regulations are encouraged.

WHO: David Blumenthal, M.D., M.P.P., national coordinator for health information technology
Jonathan Blum, director, Center for Medicare Management
Cindy Mann, director, Center for Medicaid and State Operations

WHAT: Briefing for HITECH Partners and Stakeholders – Providers, HIT Industry Organizations

WHEN: Wednesday, Dec. 30, 2009
5:15 p.m. – 6:00 p.m. Eastern Time

WHERE: Toll-Free Dial: (800) 837-1935
Conference ID: 49047605
Pass Code: HITECH

December 30, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

‘Today’ and Redbook notice mobile PHRs

Regular readers know about my skepticism toward personal health records, given the minuscule level of consumer acceptance. Manhattan Research highlighted the low uptake of PHRs in a study released Jan. 15.

“Despite significant interest in this type of service, only 7 million U.S. adults actually use PHRs,” the company said. “Compelling offerings from vendors ranging from Google, WebMD, and Microsoft to multiple insurers and employers have sparked buzz around PHR in the past year. But for average consumers not motivated by a serious illness, significant barriers such as privacy concerns, lack of understanding, and doubts to PHR efficiency hinder adoption”

At least one consumer publication thinks that might change this year. Last Friday on NBC’s “Today Show,” Redbook health editor Camille Chatterjee talked about the magazine’s 10 health trends for 2009.

Amongst such topics as the Wii Fit and, ahem, vaginal fitness, Chaterjee included online and mobile PHRs, specifically mentioning AllOne Mobile and Microsoft’s HealthVault.

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The PHR discussion starts at about 2:00. You can read the accompanying story here. Also, check out the podcast I did with AllOne Mobile’s Frank Avignone last year.

Meanwhile, HIMSS last week released a new book, “Personal Health Records: The Essential Missing Element in 21st Century Healthcare,” by Dr. Holly Miller, Dr. Bill Yasnoff and Howard Burde, all familiar names in health IT circles.

This follows on the heels of CMS launching a PHR pilot for Medicare beneficiaries in Arizona and Utah.

Are all these developments more hype or do they represent real progress?

January 26, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: Dr. Robert Kolodner on the national HIT strategy

I love the annual Association of Medical Directors of Information Systems (AMDIS) Physician-Computer Connection. It’s a chance to hear some of the smartest and most accomplished people in healthcare, namely medical informaticists, in a small, informal setting. This year’s event, held last week in beautiful, laid-back Ojai, Calif., featured an appearance by Robert Kolodner, M.D., the national coordinator for health information technology.

After Dr. Kolodner’s presentation—more of a Q&A with his peers in medical informatics—he graciously sat down for an audio interview with me. Here is the result.

Podcast details: Robert Kolodner, M.D., on the national health IT strategy. Recorded July 16, 2008, in Ojai, Calif. MP3, stereo, 64 kbps, 14.3 MB, running time 31:24.

0:40 Background on
national health IT strategic plan toward interoperable electronic health records
3:35 Goals of the plan
4:08 Distinction between “health” and “healthcare”
5:25 Explanation of “patient centeredness”
6:20 Physicians’ role in promoting patient centeredness
7:30 IT’s role
8:50 Population health
10:40 Why physicians should care about national IT strategy
12:55 Making the issue personal
13:35 Financial incentives for technology adoption
14:37 Incremental advances
16:18 Medicare e-prescribing incentives as one step in a series of improvements
17:30 Convincing healthcare organizations to cooperate
18:08 Greater public awareness about electronic health information
18:32 Privacy and security concerns, and coming framework
20:50 Convincing doctors to share data
22:10 Trial National Health Implementation Network implementations
22:55 Where physician IT leaders can make a difference
24:06
AHIC successor
25:25 Complexity of healthcare in the U.S. and abroad
27:18 Profound workflow changes from IT and maximizing skills of healthcare professionals
29:06 Possible effects of 2009 administration change
30:15 Health IT’s fundamental role in healthcare reform

July 22, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Congress includes eRx in Medicare bill

Finally Congress has paid more than lip service to health IT. Late yesterday afternoon, the Senate approved the Medicare Improvements for Patients and Providers Act of 2008, halting the planned 10.6 percent physician fee rollback and, significantly, including financial incentives for physicians to move to electronic prescribing.

Reportedly, Sen. Edward M. Kennedy (D-Mass.), a strong advocate of health IT, surprised a lot of his colleagues by returning to the Senate in time for the vote, his first appearance there since his cancer surgery last month.

According to the eHealth Initiative, calls for bonuses of up to 2 percent for providers who use “qualified” e-prescribing systems for five years, beginning in 2009. Starting in 2012, providers would be subject to 2 percent penalties for not writing electronic scripts. The Department of Health and Human Services would have the option of adding a hardship exemption for certain providers.

This is not a done deal, however, as President Bush has threatened to veto the legislation over its proposed Medicare Advantage cuts. The bill passed the Senate by unanimous consent, but the eHealth Initiative says 69 senators voted in favor, making the margin veto-proof. The House vote on June 24 was 355-59, also enough to override a veto.

July 10, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Update

In my Dec. 27 post, I referenced a letter from HHS Secretary Mike Leavitt to members of Congress regarding EHRs and the planned 10.1% Medicare physician fee cut for 2008 that eventually was postponed for six months.

I said that the letter was not available online. I was wrong. Here it is.

It seems I confused that letter, from Leavitt to Senate Finance Committee leadership, with another one from members of the Senate regarding e-prescribing. In the latter correspondence, 19 senators asked Attorney General Michael Mukasey to push the Drug Enforcement Agency to revisit its ban on electronic prescribing of controlled substances.

Sen. Sheldon Whitehouse (D-R.I.) issued a press release about that Dec. 17 letter. The letter followed a Dec. 4 hearing on the topic in front of the Senate Judiciary Committee. In the interim, on Dec. 10, the Justice Department included electronic prescriptions for controlled substances on its semi-annual regulatory agenda (see page 70083). That means expect a proposed rule change within the next six months.

As the Washington regulatory machine plods along and the presidential primary season kicks into high gear, please don’t ask me to make any predictions on the EHR/Medicare issue, or, for that matter, on the Medicare fee debate now on hold for a few months.

I will say again, however, that I believe Congress seems to have the will to make major changes to Medicare about once a decade, and that already happened this decade with the Medicare Prescription Drug Improvement and Modernization Act of 2003. Call me cynical (and many have), but I don’t see anything big happening in a presidential election year.

Meanwhile, I’m trying to arrange something super cool: a ride-along in an all-digital ambulance. Hopefully not as a patient. Stay tuned.

January 8, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Year-end thoughts

Ah, another long delay between posts. Some people blog for fun. When you write for a living, you do other stuff when you need to take a break. Like sleep in or watch too much TV.

I have just a couple of things to say before the end of the year. So here goes.

Everyone’s offering a personal health record. Few are using them. I’ve written about that plenty this year. I’m now declaring a personal moratorium on PHR stories until someone gives me evidence that patients and physicians are actually using PHRs. There, I said it. Hopefully I’ve just saved myself from a dozen more HIMSS meeting requests. But not likely.

Secondly, I thought it was remarkable that HHS Secretary Mike Leavitt wrote to members of Congress, asking that any legislation to address the 10 percent Medicare fee cut for 2008 include incentives for EHRs and give CMS the authority to require e-prescribing in the future. Could it be that a the Bush administration was asking Congress for something close to a mandate? Not exactly, but it sure got my attention. (Unfortunately, I could not find a copy of it online, but I have a paper copy around here somewhere that perhaps I’ll scan and post as soon as I find it.)

As it turned out, the impetus for the letter came from the American Health Information Community, as detailed in my Digital HealthCare & Productivity story from a couple weeks ago. I had an interview with AHIC member Lillee Gelinas, chief nursing officer of VHA, who gave me a nice play-by-play of the surprisingly quick process.

And as it turned out, the letter didn’t do much on Capitol Hill. Congress postponed the Medicare day of reckoning for six months, offering yet another year-end Medicare Band-Aid and setting up the possibility of a midyear Band-Aid next summer. That legislation didn’t have any health IT provisions, which isn’t surprising, given that Congress already has denied a funding increase for the Office of the National Coordinator for Health Information Technology in 2008.

Is it me, or did 2007 actually mark a regression in health IT on the federal level?

I’ve observed that Washington seems to gather the political will for serious Medicare reform about once a decade, and it already happened this decade, with the 2003 Medicare Prescription Drug Improvement and Modernization Act. Meanwhile, 2008 is a presidential election year, so don’t expect any major revisions to the Medicare payment structure next year either. That means there won’t be any incentive money for EHRs beyond the small-scale demonstration projects already in place, as authorized by the 2003 MMA.

Pessimistic? Perhaps. Realistic? I think so.

Health IT might get some lip service in the presidential campaign, but as I wrote in November, it hasn’t been a top-tier issue for the candidates.

As I post this entry, I see that the odometer has just turned over to 30,000 visitors to this site since I started tracking more than three years ago. Thanks for reading, and happy new year.

December 27, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: SureScripts COO Rick Ratliff on proposed Medicare e-Rx rule changes

Right before America effectively shut down for an Independence Day that fell on a Wednesday and surely prompted some very long weekends, the Centers for Medicare and Medicaid Services proposed some modifications to various Medicare payment and provider eligibility rules. Among the proposals is a plan to remove computer-generated faxing from the CMS definition of electronic prescribing.
alter the Medicare Part D electronic prescribing regulations.

This move is bound to make some e-prescribing advocates very happy, particularly on the pharmacy side and among the patient-safety crowd. Case in point is Rick Ratliff, chief operating officer of e-prescribing connectivity network SureScripts, who joins me for this podcast to discuss the CMS proposal and the future of e-prescribing.

Podcast details: Interview with SureScripts COO Rick Ratliff on proposed Medicare Part D e-prescribing regulations. MP3, 64 kbps, 10.2 MB, running time 22:14.

1:00 What SureScripts does
2:08 Fax exemption in existing rule
3:07 What CMS is proposing
4:02 Impact of the proposed change
4:26 What vendors might have to do
5:37 Lack of financial incentives in Medicare e-prescribing rules
6:35 Why it’s a “potentially enormous” change
7:45 Two-way communication in e-prescribing
8:35 Savings from efficiency gains
9:33 Private payers following the lead of CMS
10:00 True electronic prescribing vs. electronic faxing
11:30 Public comment period for the proposal
12:43 What SureScripts might tell CMS
13:22 How to encourage physicians to adopt e-prescribing
15:02 Physician attitudes toward patient suggestions
16:45 The tipping point
17:50 Is this a competitive battleground for pharmacies?
18:37 How retail pharmacies view e-prescribing
19:30 Effect of e-prescribing on patient and physician expectations
20:07 New SureScripts technology to report back to physicians on fill rates
21:25 E-prescribing effect on healthcare quality

July 5, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.