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Meaningful Health Care Informatics Blog

Apr 3 2011   9:29PM GMT

CMS’ new rule under Affordable Care Act and its technical implications



Posted by: RedaChouffani
ACOs, CMS, GPRO

The Centers for Medicare & Medicaid Services (CMS) has proposed a new rule under the Affordable Care Act (ACA) to help doctors and hospitals improve coordination of care for Medicare patients. The proposed rule is in relation to Medicare payments to providers and suppliers participating in ACOs (Accountable Care Organizations), and has a 60 day public comment period, allowing all providers and other entities to comment and provide feedback for CMS to review.

There are five areas discussed in the proposed ruling:

·  Patient/Caregiver Experience

·  Care Coordination

·  Patient Safety

·  Preventive Health

·  At-Risk Population/Frail Elderly Health

It is clear from the document and some of the requirements that there is a significant continuum of push for electronic health records (EHRs). Currently, the ruling requires that at least 50% of an ACO’s primary care physicians must be meaningful EHR users, using certified EHR technology as defined in §495.4, in the HITECH Act and subsequent Medicare regulations, by the start of the second performance year in order to continue participating in the Shared Savings Program.

One addition whose development will be interesting to follow is the need to report the data out to CMS. It has been proposed to use similar methods that have been successfully utilized in the past, such as PQRI registries. However, with the new measures required for ACO reports, it has been indicated in the document that there will be a new method for reporting the data back to CMS. Based on the different measures proposed, there are approximately five different types of data submission methods:

          · Information submitted via Claims (x12 or CMS 1500) for a subset of the measures.

          · Group Practice Reporting Option (GPRO) Data Collection Tool for some of the clinical data

          · Electronic prescriptions (which is tracked currently under the submitted G-Codes via claims data)

          · Data on meaningful use and what will likely come out of the current MU web portal

          · Claims or CDC National Healthcare Safety Network

The GPRO tool would most likely have the most significance in terms of data reporting for ACOs. The tool will allow submission of clinical and administrative information from EHRs, registries, and the like. The current tool is web based, but we will most likely see interfaces being developed for this tool in the future.

The rules can be accessed via the following link: www.ofr.gov/OFRUpload/OFRData/2011-07880_PI.pdfThe document contains several details on what the ACOs will require. This is a good time for many to review the proposed ruling and provide comments on things that may be of concern to them. Public comments are due by May 30.

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