This week CMS released the proposed rule for accountable care organizations (ACO) (http://www.ofr.gov/OFRUpload/OFRData/2011-07880_PI.pdf). In doing so, CMS provided a look at the next stage for advancing its definition of meaningful use of information technology.
The proposed rule establishes a Medicare Shared Savings Program that exceeds what’s necessary to prove Stage 1 electronic health records meaningful use. Compliance with coordination of care requirements suggests using several approaches. This includes, predictive modeling to anticipate care needs, remote monitoring of patients, TeleHealth, comparative benchmarking, and the establishment and use of health information technology. Additionally, including electronic health records and an electronic health information exchange enables the provision of a beneficiary’s summary of care record during transitions of care both in and out of the ACO.
In implementing these value-based purchasing initiatives, CMS hopes to improve quality. Value-based payment systems and public reporting should rely on a mix of standards, processes, outcomes and patient experience measures, including measures of care transitions and changes in patient functional status. Across all programs, we seek to move as quickly as possible to the use of outcome and patient experience measures. To the extent practicable and appropriate, these outcome and patient experience measures should be adjusted for risk or other appropriate patient, population, or provider characteristics.
The rule contains 65 new quality metrics scattered across five categories, many of which address the issues of chronic diseases. There are very granular metrics in the rule that will determine how much savings can be shared for treatment of specific chronic diseases. These are specifically focused on quality.
For all Medicare providers these proposed uses of information technology suggest what they may be expected to demonstrate in the near future.