As the final rule on ACOs ( Accountable
Care Organization) has come out, it is apparent that that the value that EMRs
(electronic medical records) bring is unprecedented. Under the Medicare Shared Savings Program,
ACO participants (which may include medical practices, hospitals and payers)
are graded and paid based on 4 domains of care quality: 1) patient
experience; 2) care coordination and
safety; 3) preventative health; 4) at-risk
populations. The program consists of a 3
year performance period in which the performance of the ACO mapped against
thresholds set by CMS. To reap financial
benefits from this program, providers must report on 23 of 33 quality measures
spanning these 4 domains during the second year and 33 out of 33 in the third. Some
of the measures, like # 20, which asks for the percentage of providers that
have received Meaningful Use money are easy to satisfy if you have a Certified
EMR.
ACO participants are incented to work
together and efficiently because if they don’t meet the CMS thresholds they
must pay money back. Data is key when trying to coordinate care and the exchange
of clinical data must be done properly to meet the quality measures set by CMS.
Now it must be apparent to medical providers
that if they want to join an ACO it is very important that they are comfortable
using an EMR. The good news is that there are certain features of the software that
allow providers to capture the necessary data for ACO quality measures easily.
For example, in the Preventative Health domain there are measures such as Adult
weight screening and follow-up and Tobacco Use Assessment. Both of these are
Meaningful Use criteria and any certified EMR has screens and buttons to record
this information.
In another example, the domain of at-risk
population contains a diabetes composite measure in which the number of
diabetics who BP is less than 140/90 must be recorded. To do this, it may
necessary to setup a report in which there are fields to search for a patient’s
diabetic status and their blood pressure level concurrently. For instance, in
Patagonia Health’s EMR, there is a section called “My Reports” where users can
fully customize search criteria for certain disease conditions, procedures and demographic
characteristics.
Finally, the exchange of health information
between providers and entities requires ability for the system to send and
receive data securely and in a format that the receiving end would be able to
decipher. Exchange of clinical data is a Meaningful Use criterion and is done
through CCR (care of continuity record) which generates a summary of the usually
about the patient’s medication, laboratory, immunizations, provider names, vital
signs, alerts. Providers simply need to press the CCR button and it generates a
file. This file can then be sent in encrypted format through email currently (and
through Health
Information Exchanges later) to the other provider’s EMR.
EMRs have become a powerful tool that has empowered
medical providers to collect the necessary data in order to provide medical care
with a sense of accountability and level of quality in the form of an ACO. The
Meaningful Use Program has further enabled different EMRs to have the standard features
important for this data collection.
.
