Posts Tagged ‘Legislation’

Paper Weaving

Under the burden of new regulations, the future of ACOs is unclear.

It seems that many groups that were once supportive of the program are now expressing deep reservations. Indeed, the discontent appears to be deeper than what might be expected as agreeable platitudes evolve into hard and fast rules. Modern Medicine quotes one organization calling the new regulations a “deal killer.” At least 7 members of the US Senate have asked CMS to withdraw the proposed regs.  But the complaints don’t end there.

The Patient Centered Primary Care Collaborative found that “that the technology needed to support the ACO model either doesn’t exist or is so misaligned with the meaningful use of electronic medical record (EMR) technology that health care providers are going to have a tough time participating in both.”

Cleveland Clinic CEO Toby Cosgrove wrote an open letter to CMS Administrator Don Berwick saying the regs are,

“replete with prescriptive requirements that have little to do with outcomes…

“Further, we have concluded that the shared savings component (Shared Savings) is structured in such a way that creates real uncertainty about whether applicants will be able to achieve success.”

The American Medical Group Association reports that as the regulations currently stand, 93% of their members say they won’t enroll. The AMGA includes well-regarded institutions such as Geisinger Health System and Dartmouth-Hitchcock.
Our Take: While ACOs hold the promise of a significant break-through for patient engagement, they will obviously only work if the country’s healthcare organizations actually participate. It’s one thing to have political opponents criticizing the plan. It’s quite another to have long-term supporters, well-regarded and forward-thinking organizations like Cleveland Clinic and Geisinger Health System suddenly voicing dissent in such a public fashion. We have confidence that progress and compromise are possible on this issue. At least for now.

More information from: Modern Medicine, Becker’s Hospital Review, Search Health IT, and FierceHealthcare

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Stack 'em high

KevinMD – If you are interested in the new ACO regulations but are less than enthused about perusing this 429 page document, here are some simple take-away items to better understand the changing regulatory landscape:

• An organization must satisfy an eight-part definition of patient-centeredness in order to be considered an ACO.

• A Medicare beneficiary must sit on the board of the ACO, and CMS must approve the use of all marketing materials.

• Initially, it is being concluded that there will be very few ACOs (CMS estimates 75-150 nationwide) because of the infrastructure requirement stating that 50% of ACO doctors must be meaningful users of EHRs.

• The CMS has shifted the ACO to a shared risk approach as opposed to the “shared savings” approach of yore. The ACO may choose to share risk from day one, or it may defer the risk sharing to year three.

• Thriving ACOs that dominate over local markets may face the most complicated antitrust reviews by the FTC/DOJ.

• Scoring conducted in five domains – including patient experience of care – will determine the shared savings that will be paid to an ACO. These five domains are comprised of 65 quality metrics that are drawn from an existing set of measures.

Our Take: Patient engagement and patient-centered care are at the heart of these new organizations. These elements have remained central even as the new regulations are becoming clear. We are seeing a lot of high-profile healthcare organizations move in this direction, and we’re, honestly, excited about this developing trend. To this end, we support efforts to demystify this process.

Learn more at KevinMD

Image by ant.photos via Flickr

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Health Economist Adam Kaufman

First the good news.
Health reform legislation represents a potentially significant step towards increased prevention services and care coordination.   These changes point towards increased focus and reimbursement for programs that engage patients to understand and take control of their health behaviors and chronic conditions.

Now the bad.
In the next couple of years, we may actually see less funding for disease and chronic condition management programs. Even as health reform promotes the concepts underlying these approaches it has put a damper on their traditional means of funding. In its efforts to curb rising administrative costs at the country’s health insurers, Congress has also limited the amount of money these insurers can spend on programs that are not directly fee-for-service. (more…)

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Regardless of where you stand on the new healthcare reform legislation that passed the House of Representatives Sunday night, it will clearly make a big impact on America’s health system. Other websites are doing a great job of outlining what changes occur immediately, what happens in 2014 , and what happens between now and then. Here at Engaging the Patient, we asked how new legislation might impact patent engagement. We read the Senate bill, the House of Representatives reconciliation bill, and yes, even the Manager’s amendment.

While the 2,700 pages had no plot or character development, it did have 5 key provisions that impact patient engagement…

(more…)

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