ACOs key to healthcare overhaul, Berwick says
The new proposed regulations on accountable care organizations, released Thursday by the Department of Health and Human Services, launch one of the first delivery-reform initiatives to be implemented under the Accountable Care Act.
That's what Donald Berwick, MD, administrator of the Centers for Medicare and Medicaid Services had to say in his new article published in conjunction with the regulation's release on Thursday.
In a March 31 article published in the New England Journal of Medicine, Berwick said the purpose of ACOs will be to foster change in patient care so as to accelerate progress toward a three-part aim: better care for individuals, better health for populations, and slower growth in costs through improvements in care.
The regulation does not specify how much incentives providers will earn participating in the voluntary program.
ACOs create incentives for healthcare providers to work together to treat an individual patient across care settings, according to HHS Secretary Kathleen Sebelius. Medicare Advantage plans will not be included in the ACO program.
S
ebelius said, to share in savings, ACOs would have to meet quality standards in five key areas, including:- patient/caregiver care experiences;
- care coordination;
- patient safety;
- preventive health;
- at-risk population/frail elderly health.
The proposed rules also include strong protections to ensure patients do not have their care choices limited by an ACO, she added.
The rule will be published April 7 in the Federal Register, and comments will be accepted for 60 days. The rule calls for a start date of next Jan. 1. The program is expected to save $960 million over three years for the Medicare program, Sebelius said.
Before the rule is finalized, CMS will review all comments from the public and may make changes to its proposals based on the comments, according to Sebelius.
What does this mean for providers and EHR vendors?
Brian Ahier, health IT evangelist for Mid-Columbia Medical Center in The Dalles, Ore., said his first take on the 400-page proposed rule is the importance of providers first achieving meaningful use of electronic health records. The rule calls for fifty percent of providers who participate in an ACO to be meaningful users.
The group practice reporting option (GPRO), an electronic reporting tool already used by the government in the physician quality reporting system, will be updated for ACO reporting use, Ahier said.
It will be key that interface between certified CHRs and the GPRO works smoothly. "This poses a real business opportunity for EHR vendors," he said.
"If nothing else, I think we are seeing the unfolding of a plan for how the meaningful use program is going to be used in the implementation of new payment models," Ahier said.
William F. Jessee, MD, president and CEO of the Medical Group Management Association said doctors should beware of the complexities found in the proposed rule.
"Physician practices need to thoroughly examine how participation in ACOs may affect their practice operations," Jessee said.
Despite whether doctors are fearful of participating or not, one expert predicts CMS will be conservative on the number of doctors it allows to participate initially. Jeff Gruen, director of Health Care Services at PRTM, a global management consulting firm, predicts CMS will keep the program small at first. "CMS is caught in a vicious dilemma: They need to keep momentum for the ACO program to convince providers to invest in ACOs for the long term," he said. "If the program is too restrictive early on, interest in ACOs could lose steam."
Justin Barnes, chairman emeritus, of the Electronic Health Record Association (EHR Association) said the proposal reveals a plan that will affect something much larger than meaningful use. "This is going to affect our entire healthcare system," he said.
"That's why the anticipation was so great for this proposal," he said. "This lays the initial foundation of what our new healthcare system can look like."
Blair Childs, senior vice president of public affairs, Premier healthcare alliance, said, "This new model of care delivery represents one of our best hopes for overcoming fragmentation in care delivery."
Follow Diana Manos on Twitter at DManosHFN for more analysis of the ACO proposed rule.
