ACOs, EHRs and small practices

Many health care providers are wondering about the new Medicare shared programs for Accountable Care Organizations (ACOs). For the patient, ACOs could promise more “Accountable” medical care that may lead to improved Health outcomes. However, it is important that ACO guidelines are comprehensive to prevent things like “cherry picking” by providers. This means a provider would choose the healthiest patients in order to obtain panels that will have better Health outcomes. This defeats the purpose of health reform which is to expand coverage to patients with chronic diseases who have traditionally had bad outcomes. But let’s say that no one is able to do those kinds of things. Then this could be a win for the patients.

For healthcare providers ACOs could be a hard nut to crack. Even with an efficient Electronic Health Record System (EHR), it may be harder for the smaller practices to comply with the recently released guidelines and quality measures. Management in ACOs not only demand efficient coordination of care for individual patients but it requires effective management of the business operation including partnerships with various Healthcare services (Hospitals, specialist, ancillary services, etc). If the ACO cuts cost and manages a tight ship, profits can be shared. If not, the operation could operate at a loss.

However, ACOs could be a good thing. If done properly we can improve patient access, improve community health, and decrease morbidity and mortality among the population. It can allow for Primary Care Providers to become more in control of the care of their patients as well as the financial management within the ACO. However, ACOs could be a bad thing. If the concept is not managed properly, the smaller practices are at risk to be gobbled up by larger practices that have more robust EHR, IT, administrative and financial management systems. As you see, I can’t make up my mind.

Aren’t the “Meaningful Use” financial incentives from Medicaid and Medicare meant to help smaller practices to implement technology for the purpose of keeping them in the Healthcare game? In our efforts to improve Health outcomes, patient access, and cut cost, let’s assure that there are opportunities left for smaller practice to remain independent. These are the folks who serve those smaller communities who desperately need Healthcare providers.

3 comments Add your comment

susan

June 14th, 2011
2:01 pm

ACOs “could” be a good thing for the patients. Providers get incentives for keeping her healthy and she gets treated for her “whole body.” Patients may begin to see the links between, say, good dental hygiene and eating more veggies. And they may feel more comfortable asking questions. I found this helpful: http://whatstherealcost.org/video.php?post=five-questions

[...] Atlanta Journal Constitution: ACOs, EHRs And Small Practices Many health care providers are wondering about the new Medicare shared programs for Accountable Care Organizations (ACOs). For the patient, ACOs could promise more “Accountable” medical care that may lead to improved Health outcomes. However, it is important that ACO guidelines are comprehensive to prevent things like “cherry picking” by providers. This means a provider would choose the healthiest patients in order to obtain panels that will have better Health outcomes. This defeats the purpose of health reform which is to expand coverage to patients with chronic diseases who have traditionally had bad outcomes. But let’s say that no one is able to do those kinds of things. Then this could be a win for the patients (Dominic Mack, 6/13). [...]

Daniel

August 22nd, 2012
3:29 pm

CMS, OIG, and HHS will closely moontir ACOs entering into the program in 2012 through June 2013, and plan to narrow the waivers if they result in the unintended effect of shielding abusive arrangements.a0 The waivers could be narrowed by modifying the waivers to add or substitute conditions to the waivers; limiting ACO arrangements involving referral sources to those that are fair market value or commercially reasonably or involve services performed by the referral sources; preclude waiver protections for arrangements that involve individuals or entities that are not part of the ACO; or include a requirement that ACOs submit reports regarding their arrangement.a0 CMS and the OIG seek comments on these approaches to narrow the waivers.Source: omwhealthlaw.com