Whether you agree with the health IT CIOs comprising the College of Healthcare Information Management Executives (CHIME) or not, you’ve got to give them props for not holding back in their comments to the Centers for Medicare and Medicaid Services (CMS) regarding the agency’s proposed accountable care organization (ACO) rule.
The rule, mandated by health care reform, sets up primary care physicians as patient care coordinators. ACOs receive a piece of the savings such management should, in theory, accomplish.
CHIME’s beef was not with the health reform or the ACO rule, per se, but with the added layer of performance initiatives that participating in the program would require — burdening hospital information technology infrastructures already deep into implementing other CMS projects such as meaningful use, e-prescribing, the Physician Quality Reporting Initiative (PQRI) and core measures reporting.
From CHIME’s perspective, the best outcome would be for CMS to examine all these initiatives and harmonize the requirements to save work and streamline the reporting process, said the comments, signed by CHIME president and CEO Richard Correll and CHIME trustee board chair Dr. Lynn Vogel. That and lift the requirement that 50% of an ACO’s participating physicians meet all meaningful use requirements — sticking to patient outcomes goals instead of commingling ACO performance with meaningful use compliance.
Speaking of outcomes, the reporting of all these quality measures looks to be somewhat of a headache once the CIOs charged with implementing the ACO rule take a hard look at what back-end technology support it’s going to take to achieve compliance with it and the other abovementioned quality initiatives: “If CMS insists on keeping these and other duplicate measures, CHIME believes it would be appropriate for CMS to calculate these and other measures on an aggregated basis, rather than have providers compile and produce report cards,” the document read.
CMS “insisting” on keeping “duplicate measures.” Strong stuff.
Later, CHIME suggested that the health information exchange (HIE) requirements in the ACO rule — carrying a deadline of next Jan. 1 — reflect an “aggressive” outlook toward the construction of a national health IT infrastructure and electronic health records adoption. That doesn’t even take into consideration the headache caused by patients who opt out of sharing claims data, which our friends at Health Data Management break down in a well-put-together piece.
At the American Telemedicine Association (ATA) conference earlier this month, I asked outgoing association president Dr. Dale Alverson what the deal was with a similarly strongly worded comment letter his group sent to CMS asking them to hardwire more telemedicine services into the ACO rule. To me, it looked like a brassy move for a group who was essentially asking CMS to grant them a favor.
In not so many words, Alverson basically said: That’s how CMS likes it. And who could argue? While ATA hasn’t heard back yet on its proposed changes to the ACO rule, it did get a major win when CMS chief Dr. Donald Berwick told Alverson on the eve of the ATA annual meeting that it would ease proposed telemedicine credentialing rules — another policy issue ATA had been pushing for some time, which soon manifested itself in a final rule published during the ATA meeting and will go into effect July 2.
Answering an audience question in a workshop at the Massachusetts Health Data Consortium Governor’s conference last week, CMS associate regional administrator Dr. William Taylor said during a question and answer session that CMS employees read every publicly submitted comment on proposed rules such as this one for ACOs. And that the people who read them do consider every last idea proposed.
So CHIME, you go. Bring it on, and see what happens.