The Buzzword For HIMSS11 — ACOs
By Ken Congdon, editor in chief, Health IT Outcomes
This year's HIMSS Conference and Exhibition, held February 21-23 at the Orange County Convention Center, had a lot of things going for it. It was held in a warm weather location (Orlando, FL). It boasted a lineup of influential keynote speakers (e.g. Robert Reich, Kathleen Sebelius, Dr. David Blumenthal, and Michael J. Fox). And, it broke attendance records with 31,225 attendees. However, all of these noteworthy features paled in comparison to the buzz throughout the conference and on the exhibit floor surrounding ACOs (Accountable Care Organizations).
What Is An ACO?
I often have a difficult time landing on a few newsworthy topics to cover in these post-show write-ups, but this year, the article basically wrote itself. ACOs were the topic of conversation everywhere at HIMSS11. By definition (or one of the many available definitions at least), an ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. According to the new law, ACOs would agree to manage all of the healthcare needs of a minimum of 5,000 Medicare beneficiaries for at least three years.
ACOs change the healthcare game in many ways, but most of the focus (and concern) revolves around how physicians and hospitals will be paid by Medicare under the ACO model. The goal of ACOs is to place the focus on patient outcomes rather than patient services. In Medicare's current fee-for-service payment system, doctors and hospitals are paid based on the procedures and tests they perform on patients. In theory, the more tests they order and procedures they perform, the more they are compensated.
This model doesn't do much to encourage physicians to access and rely on data that may already be present in the patient's health record. For example, why seek out and rely on a recent MRI performed by another physician (that you'll receive no compensation for), when you can be paid for ordering a new MRI to make or confirm a diagnosis. In reality, there may be no good reason to order this additional test, but the current system often makes it easier for good doctors to reorder tests and procedures, rather than track down and leverage data that already exists.
ACOs wouldn't necessarily do away with fee for service, but it would create savings incentives by offering bonuses when providers keep costs down and meet specific quality benchmarks, focusing on prevention and carefully managing patients with chronic diseases. In other words, in an ACO model, providers will get paid more by keeping their patients healthy and out of the hospital. At the same time, this model is expected to cut billions of unnecessary costs out of the U.S. healthcare system. In fact, the Congressional Budget Office estimates that ACOs could save Medicare at least $4.9 billion through 2019. This is less than one percent of Medicare spending during this period, but if the program proves to be successful, it can be expanded.
HIMSS-Specific ACO Buzz
The ACO initiative isn't scheduled to launch until January 2012, but the race to form ACOs has already begun. This was evident at HIMSS11 as several technology vendors promoted how their products and services helped facilitate the transition to an ACO model. Hospital leaders in attendance were eager to learn more about these technologies, but most were more interested in seeking out information and answers about the ACO model in general. The ACO concept is still very short on details, and if it's one thing hospital CEOs, CIOs, and CMIOs hate, it's the unknown.
Most of the discussion I witnessed at HIMSS revolved around the expected pace of the transition to ACOs. There was apprehension among the attendees about forming an ACO too quickly. First, there was the all-too-real pain of ACOs being yet another government-imposed health IT initiative that hospital CEOs, CIOs, and CMIOs will be burdened with managing over the next few years. Many sought direction as to the priority level they should place on an ACO transition in light of the EHR Meaningful Use, ICD-10, and HIPAA 5010 projects most already have underway. Second, there was a palpable fear among attendees regarding the financial damage forming an ACO too early could have on their healthcare facilities. In general, this fear revolved around the lost revenue that a hospital could realize if it transitioned to an ACO before the government or payer community was prepared to issue payments in line with the ACO model. Most of the attendees I spoke with were skeptical of making immediate ACO moves or technology investments because of the uncertainty that still surrounds the concept.
Other Notable HIMSS Observations
While ACOs were by far the hottest topic at HIMSS11, there were a few other evident trends worthy of mention.
Meaningful Use Reality Check — According to a HIMSS Analytics survey released during HIMSS11, 44% of the 999 hospitals interviewed said they were "likely" or "most likely" to meet Stage 1 Meaningful Use requirements. Furthermore, 58% indicated that they expected to meet Stage 1 measures by May 2012. These numbers fall short of some earlier estimates by the analyst community, but were a clear reflection of my interactions at the conference.
It appears there are still several obstacles preventing the provider community from adopting EHRs and implementing Meaningful Use core measures. The absence of Stage 2 and Stage 3 definitions seems to be the primary sticking point. Many of the CIOs and CMIOs I spoke with were hesitant to build EHR infrastructures for the long haul when there was still uncertainty surrounding what the Stage 2 and 3 Meaningful Use criteria will be. Many feared they might have to revamp much of what they would put in place to meet Stage 1 Meaningful Use, once the Stage 2 and Stage 3 requirements are announced. Moreover, others feared there was a chance the EHR vendors they choose to align themselves with might not be able to achieve Stage 2 and Stage 3 certification once this criteria is released. Whether you feel these fears are warranted or reflect a lack of leadership is up to you, but they are clearly impeding the progress of EHR Meaningful Use.
That being said, there are some positive Meaningful Use statistics to share. For example, 21,000 healthcare providers have registered for Medicare and Medicaid Meaningful Use incentives to date and $29 million in incentive payments has already been paid out.
Tablets Take Over — The tablet computer is not a new device by any means. It was a viable computing option in healthcare long before the Apple iPad was introduced last year. However, the emergence of the iPad redefined the form factor of the tablet and upped the ante as to the impact these devices could have in healthcare settings. At HIMSS this year, many other vendors (e.g. Blackberry, HP, Fujitsu, Motion Computing, Motorola) have followed Apple's lead and introduced tablet computers that mirror (and in some cases improve upon) the form factor made famous by the iPad. All of these offerings incorporate vibrant displays, long-battery life, and useful applications. However, they all provide different operating system options (e.g. some are Android powered, while others utilize Microsoft Windows). Furthermore, these competitive offerings also focus on solving some of the problems inherent with the iPad (e.g. security management and size). It remains to be seen whether any of these offerings will trump the iPad as the dominant tablet platform in the healthcare sector. However, with all of the options now available, it is becoming clear that the tablet computer is now the platform of choice for physicians to access and record patient data at the point of care.
Is The Economy Impacting Health IT Purchases?
In my last column, Despite Woeful Economy, Health IT Investing Up, I said that I would survey the buying habits of attendees at HIMSS and report back as to whether the poor economy was negatively impacting health IT purchases. I did just that, and all indications are that the economy is not slowing technology spending in the healthcare sector. Most of the vendors I spoke with said that this was one of their best HIMSS events in years (from a sales potential standpoint). Many referenced that more attendees were ready to make more immediate purchases this year, where in previous years, many were just evaluating their options. The one area where purchasing patterns were still a mixed bag were with some of the larger health IT infrastructure vendors (e.g. Siemens, McKesson, etc.). Representatives from these organizations mentioned that while they did get a good number of more immediate opportunities at the event, there was still a lot of "tire kickers." The size of the investment required to implement systems by these players and the uncertainty still surrounding system integration for Meaningful Use, ACO formation, and HIE (health information exchange) undoubtedly impacted this trend.
Ken Congdon is Editor In Chief of Health IT Outcomes. He can be reached at ken.congdon@jamesonpublishing.com.