An ACO rookie’s most common mistake

To stay competitive in an evolving healthcare landscape, independent small physician practices are creating their own Accountable Care Organizations (ACO). It’s important for them to have accurate expectations before applying to Center for Medicare & Medicaid Services (CMS) and its Shared Savings Program. Unfortunately, new ACO applicants often miscalculate the number of CMS patients, or “attributed lives,” they are responsible for, putting their entire cost structure at risk. Whose patient is it? CMS assigns each patient to a provider who will be responsible for that patient’s cost and quality of care. A sophisticated algorithm determines where this patient belongs, based on claims data. A smaller primary practice may assume that every History and Physical (H&P) it performs for Medicare patients will count toward its attributed lives total, when in fact that is not the case. For example, if that patient […]

“There’s an app for that” is a common expression proving true in healthcare IT. For example, SAMA HealthCare Services (El Dorado, Arkansas, U.S.A.) uses third-party applications to customize its electronic health record (EHR) core and improve patient-centered care. It launched eDoc4U in May 2014 to automate required annual Medicare wellness exams and assess health risks. In a recent case study, SAMA HealthCare lead physician Gary Bevill said, “We’ve pushed the envelope and look for ways to keep the patient foremost in the encounter…With Allscripts Professional EHR and eDoc4U, it was a way to further extend that goal and offer much greater value to our patients.” The big picture: Improving care in Arkansas According to the United Health Foundation, Arkansas is the second unhealthiest state in the nation, with high rates of smoking, obesity, diabetes and poverty. Lack of preventive care, […]

Many providers are finishing up their 2014 attestation period for Meaningful Use, the Centers for Medicare and Medicaid (CMS) incentive program for successful use of electronic health record (EHR) technology. Several changes in the regulations in 2014 have prompted questions. Using information available today, I’ve answered some of the most frequently-asked questions here: Q. Do we need to attest several times throughout 2015, or do we attest only one time after the end of 2015? As of today, if you’ve attested for Meaningful Use before, you only need to attest once. You will demonstrate for all of 2015 and attest before February 29, 2016.  (Exception: people who have never demonstrated before will have a 90-day demonstration period.) However, on January 29, 2015, the Chief Medical Officer of CMS issued a significant communication about some possible future adjustments to the Meaningful […]

Patient engagement is essential to improving care, but it can be a tough climb. For example, U.S. clients often note the most challenging government incentive measures are the ones that require patient response. Health First (Brevard County, Florida, U.S.A.) recognized the importance of genuine patient engagement, including millions of dollars in potential Meaningful Use incentives. Below, Health First shares how – within just a few short weeks – it achieved 52.6% of patients with online access and encouraged 6.8% of patients to view information electronically. Here are some of the successful strategies from Health First Vice President of Enterprise Applications/Informatics and Chief Nursing Informatics Officer Karie Ryan, RN, MS, BSN: 1. Remember that implementation is just a first step. During the summer of 2014, Health First implemented Allscripts FollowMyHealth® patient portal (and rebranded it HFConnect). But just building a portal […]


Finding tomorrow’s high-risk patients

As the healthcare industry offers more ways to earn risk-based or value-based revenue, providers are more proactively coordinating care, engaging patients and managing population health. Analytics are fundamental to all of these strategies, even in small practices. To be successful, physician practices need analytics that are predictive across multiple populations. They need to know who the high-risk patients are today, but they also need to identify the “rising-risk” patients. With intervention, these patients can have a healthier future. The cost of unmanaged cardiac conditions One healthcare organization evaluated its Accountable Care Organization (ACO) population with Johns Hopkins Adjusted Clinical Groups (ACG®), an industry standard to adjust risk and predict future healthcare usage. With analytics, this ACO found that more than half of its patients were either high risk (30%) or very high risk (27%). Furthermore, it found that the average […]