Guest Post: Committing to an ACO Model: Factors to Consider Before You Take the Leap

Just as value-based care can take many different forms, every path to prepare for this transition itself is unique. Some practices are moving into full-fledged ACOs quickly. Others are testing the waters with hybrid models and pilot programs.

Before taking a bold step toward accountable care, you should consider the following success factors:

Leadership and internal culture

To manage this transformation, your organization must be able to attain buy-in at all levels. This begins with a leadership team that is aligned with the vision and willing to invest in it. Leaders must spearhead change management efforts and effective internal communications. Driving quality and innovation will also require input from all staff, both clinical and non-clinical. This will be easier to accomplish if your culture already promotes collaboration and openness to new ideas.

Technology and infrastructure

If your practice uses basic electronic medical records (EMRs), there are additional investments ahead. Actionable patient data will be the driving force of improved quality of care. Rather than offering volumes of patient data to providers, information must be targeted and meaningful.

There is much focus on the need for HIE technology in an ACO or population-based care management initiative. However, first-generation HIE technology, which simply aggregates data, will not suffice. To support collaboration and decision-making for your panel of patients, providers will need advanced capabilities that enable the sharing of meaningful and complete data across the care continuum. This actionable data combined with analytics can also be used to create dynamic care plans that offer real-time insight for the care team and your patients.

Technology can empower your patients to make better healthcare decisions. Social media, mobile applications, and online tools are all effective outlets to engage patients. These resources can also help reduce network leakage and optimize utilization.

Level of clinical integration

Clinically integrated networks (CINs) are a strong foundation for ACOs. CINs can easily promote shared protocols, efficiency goals, education, and training. If your practice isn’t ready to move directly into a full ACO, this structure can be a good starting point.

Population health management expertise

ACOs must be able to stratify patients by risk. Based on this data, your practice can develop strategies to manage those with the highest risk / costly health conditions. Once patient data is matched with the latest clinical standards, new ways to improve outcomes may be found. This analysis of population health will also provide a good baseline for your goals around quality and measuring progress.

If your organization lacks expertise in this area, you should consider working with a health plan that has proven expertise. Care coordination payments from these health plans can help you plan for these infrastructure investments.

Market growth potential

Practices in a highly competitive market will likely be motivated to take on risk in hopes of greater rewards. Market growth will also be an important strategy to offset reduced utilization. Organizations that can readily attract and retain patients will have a distinct advantage.

Whether you’re creating a full ACO or a pilot program, these factors should be considered prior to launch. By preparing to face these challenges now, your practice can position itself for a sustainable future.

Bruce Henderson is head of Integrated Solutions, Aetna Accountable Care Solutions.

News 1/15/13

From Maple Man: “Re: EHR petition. Dr. William Zurhellen is a solo pediatrician who believes EHR certification should focus on improving care and that anything else is a waste of time. He has now started a petition of the Obama administration to change the direction of EHR technology so it is focused on healthcare outcomes and controlling costs.” The petition notes that current technology is designed to enhance payment rather than clinical outcomes, adding, “Elements needed are episodes of care, continuous quality improvement, statements of relative outcome, and full integration with practice management tools.” The petition will be delivered to the White House for review if it gets 25,000 signatures, so exercise your First Amendment right if you are inclined.

Speaking of free speech, SRS CEO Evan Steele posts a note to National Coordinator Farzad Mostashari expressing concerns about the future of the EHR incentive program, which he believes is “plagued by rampant dissatisfaction among physicians.” Steele believes the program is too complex and may fail unless it is simplified to focus on e-prescribing, quality reporting, and interoperability. I am not disagreeing, but I wonder if provider perceptions would improve  if the industry offered more user-friendly technologies that handled more of the minutiae in the background.

The FACES Foundation, which provides cleft lip/palate care for indigent and medically isolated patients, buys SOAPware EHR .

Almost 21 percent of primary care physicians report that their personal income fell more than 10 percent in 2012, while an additional 16 percent say their income dropped 10 percent or less. Almost 40 percent of primary care physicians and most pediatricians reported incomes of less than $150,000 a year.

Rep. Nydia Velazquez (D-NY) introduces a bill that would provide SBA loan guarantees of up to $350,000 for single practitioners and $2 million for group practices for the purchase EHRs and other clinical HIT systems.

HIT lawyer Howard Burde offers advice for physicians contracting with a cloud-based EHR vendor, including recommendations that the contract spell out when and how a practice has access to data; how security is assured; how often backups are made and where they’re stored; how frequently services are upgraded; and how often the system is unavailable.

Lincoln Orthopaedic Center (NE) selects the SRS EHR, PACS, and Patient Portal for its 14 providers.

CMS publishes an EHR MU tip sheet to help specialty providers meet MU requirements, including clarification on required core, menu, and clinical quality measures; using data entered by other providers; defining office visits; and applying for hardship exemptions.

Analysis published in Health Affairs suggests that the projected primary care physician shortage could be eliminated if small practices shifted as little as 20 percent of their patients to non-physician providers and used an EHR. The authors’ conclusions are in part based on the assumption that greater use of EHRs improves a practice’s efficiency and allows more patient to be seen. Obviously not all providers concur with that assumption.

E-mail Inga.

Bowtie Confidential 1/11/13

Data Governance in Practice

In today’s complex healthcare environment, data governance is an emerging discipline with an evolving definition. The discipline embodies a convergence of data quality, management and policy, business process, and risk management. Through data governance, organizations are exercising control over the processes and methods used by their data stewards and custodians. It is important that data governance, management, and architecture be seen as more than an IT responsibility, but also as the responsibility of end users.

Data governance is a quality control discipline for assessing, managing, using, improving, monitoring, maintaining, and protecting organizational information. It is a system of decision rights and accountabilities for information-related processes, executed according to agreed-upon models which describe who can take what actions, using which methods, with what information, and under what circumstances.

In other words, data governance is a set of processes that ensures that important data assets are formally managed throughout the enterprise. It allows people to trust the data, and holds people accountable for any adverse event related to data quality. Governance is about putting people in charge of fixing and preventing data issues so that the enterprise can become more efficient.

Data governance also describes an evolutionary process for a company, altering the company’s way of thinking and setting up the processes to handle data so that it may be utilized by the entire organization. It’s about leveraging technology when necessary to help aid a process. When companies gain control of their data, they empower their people, set up processes, and get help from technology to do it. Goals may be defined at all levels of the enterprise and may aid in acceptance of processes by those who will use them. Some goals include:

• Increasing consistency and confidence in decision making
• Decreasing the risk of regulatory fines
• Improving data security
• Maximizing the income generation potential of data
• Designating accountability for information quality
• Improving planning by supervisory staff
• Minimizing or eliminating re-work
• Optimizing staff effectiveness
• Establishing process performance baselines to enable improvement efforts

These goals are realized by the implementation of data governance programs, or initiatives using change management techniques.

While data governance initiatives can be driven by a desire to improve data quality, they are more often driven by external regulations. Examples of these regulations include Sarbanes-Oxley, Basel I, Basel II, HIPAA, and a number of other data privacy regulations. To achieve compliance with these regulations, business processes and controls require formal management processes to govern data subject to regulations. Successful programs identify drivers meaningful to both supervisory and executive leadership.

The most common theme among the external regulations is the need to manage risk. These risks can be financial misstatement, inadvertent release of sensitive data, or poor data quality used to make key decisions. The proliferation of regulations and standards creates challenges for data governance professionals, particularly when multiple regulations overlap the data being managed. Organizations often launch data governance initiatives to address these challenges.

Understanding what data governance is not can help identify what it is. In particular, data governance is not:

• Change management
• Data cleansing or extract, transform and load data (ETL)
• Data warehousing
• Database design

Data governance applies to each of these disciplines or processes; however, it is not included in any of them.

Historically, data has been collected and managed at the individual department level for its own needs. Each department has developed procedures, formats, and terminology that fit its unique situation and preferences. Without the need for integration or exchange data, inconsistencies are harmless.

Today, however mission goals and legal mandates both require large organizations to report on their activities at the enterprise/organization level. This means that such organizations need to:

• Migrate data from legacy systems into new systems and formats
• Integrate and synchronize data from varied systems that use different formats, field names, and data characteristics
• Reconcile inconsistent or redundant terminology into a single data dictionary providing agreed upon definitions and properties for each element
• Report data in standard formats with standard interpretations

Data governance is a component of data management. It provides and enforces enterprise-wide data standards, common vocabulary, and reports and promotes the development and use of standardized data. It enables the organization to more easily integrate, synchronize and consolidate data from different departments, exchange data with other organizations in a common format, and communicate effectively through shared term and report formats. (Please see figure below for graphical representation)

The implementation of a data governance initiative may vary in scope as well as origin. Sometimes an executive mandate will arise to initiate an enterprise-wide effort. Other times, the mandate will be to create a pilot project or projects, limited in scope and objectives, aimed at either resolving existing issues or demonstrating value. The data governance initiative may originate lower down in the organization’s hierarchy, and will be deployed in a limited scope to demonstrate value to potential sponsors higher up in the organization. The initial scope of an implementation can vary greatly as well, from the review of a one-off IT system, to a cross-organization initiative.

With data governance, an organization can strategically focus on improving data quality, protecting sensitive data, promoting the efficient sharing of information, providing trusted business-critical data, and managing information throughout its lifecycle.

Data governance enables organizations to convert enterprise data into a strategic asset that can be used to create competitive advantage and drive economic value. It can improve financial performance, increase operational effectiveness and efficiency. and allow full compliance with regulatory requirements.

Rob Drewniak is vice president, strategic and advisory services, for Hayes Management Consulting.

News 1/10/13

A mere 16 percent of providers met PQRS requirements in 2010, with those using registry reporting systems more likely to receive bonuses than those using claims-based reporting. Researchers from the Harvey L. Neiman Health Policy Institute say more physicians will need to improve their documentation and reporting practices in order to meet PQRS requirements and avoid lower Medicare reimbursements in 2015.

Prospira PainCare selects athenahealth’s PM/EHR as the standard platform for its network of pain management physicians and rehab specialists.

The Family Health Care Clinic, an FQHC in Pearl, MS, selects McKesson Revenue Management Solutions for billing and A/R management services.

Demand for CRNAs, midwives, NPs, and PAs continues to rise, with medical groups reporting a 17 percent increase in these positions over the last 12 months.Two-thirds of organizations say salaries for advanced practice clinicians (APCs)have risen over the last year and 53 percent intend to increase their APC workforce in 2013.

The Chicago HIT-REC selects SA Ignite’s MU Assistant to automate MU reporting and achieve one-click attestation.

More evidence that practices should not skimp on training: a Health Affairs-published study finds that primary care physicians receiving sustained and extensive technical assistance were more likely to demonstrate improvement on measures of care.

Advanced Data Systems and EyeMD EMR Health Systems integrate the MedicsPremier PM system with EyeMD EMR.

MTBC announces an upgrade program for Allscripts MyWay users and resellers that includes free data migration, implementation, and training costs for practices adopting MTBC’s ChartsPro EHR or the Practice Pro EHR/PM/RCM platform.

Something new to your right: a Tweet box that includes live Twitter updates from HIStalk Practice sponsors. The feed  includes links to a plethora of interesting and relevant HIT information so a big thank you to sponsors for providing the great content. Speaking of sponsors, when is the last time you checked out details on a new product and service? By click on a few of our sponsors’ ads you will be instantly linked to a vast world of HIT offerings. Who knows, you might happen upon something you really need. If nothing else, you are bound to impress uninformed co-workers with your vast industry knowledge.

The former owners of a billing service and physicians from four pathology groups agree to pay the Massachusetts Attorney General’s office $140,000 to settle allegations that they improperly disposed of thousands of medical records found in a public dump.

MDLIVE adds 2,300 ER, internal medicine, and pediatric specialists to its telemedicine network as part of a new partnership with ECI Healthcare Partners Telehealth.

E-mail Inga.

News 1/8/13

Athenahealth announces plants to buy Epocrates for $293 million in cash, which represents a 22 percent premium over the January 4 closing price.  Athenahealth views the acquisition an opportunity to increase its name recognition among the 340,000 physician users of Epocrates. CEO Jonathan Bush took to the airwaves Monday to discuss the purchase.

Passport Health Communications acquires California-based Data Systems Group, a provider of revenue cycle software solutions.

The 25-provider Orthopedic Associates of Dutchess County (NY) implements Sectra’s PACS.

Physician recruiters say job opportunities for physicians will be more plentiful and varied in 2013 and hospitals and groups will offer bigger incentives to entice prospective candidates. One reason for the increased demand: physicians are seeing 17 percent fewer patients than they were five years ago and working about six percent fewer hours.

The AMA and about 40 national physician organizations urge CMS to stop the implementation of the ICD-10 code set for outpatient diagnosis coding, saying the burden of the transition “will force many physicians in small practices out of business.” AMA estimates the move to ICD-10 will cost physicians between $83,290 and more than $2.7 million, depending on practice size.

Medline’s 1,100-member sales force will co-market NextGen Healthcare solutions to Medline’s customer base of physician practices and hospitals.

The Office of the Actuary at CMS estimates 2011 healthcare spending grew at 3.9 percent in 2011, which is identical to the spending growth rates for 2009 and 2010. The growth in personal healthcare spending was largely driven by increased utilization of healthcare goods and services.

E-mail Inga.