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CHIME Raises Concerns on ACO Data Sharing

 |  By John Commins  
   May 11, 2011

The ability of patients in accountable care organizations to restrict access to their personal health information is one of several hurdles that could hinder the success of the new healthcare delivery models, the College of Healthcare Information Management Executives said this week.

In a letter Tuesday to Donald Berwick, MD, administrator of the Centers for Medicare & Medicaid Services, CHIME called for a re-examination of several sections of the proposed rules that it said would create significant pressures on ACOs.

“If beneficiary claims data are withheld, the ACO’s ability to improve individual beneficiary health, as well as achieve the desired shared savings, could be compromised,” CHIME said in the letter, its public comments on the Notice of Proposed Rulemaking for governing ACOs.

“We believe that allowing ACO patients to opt out of data sharing, while maintaining their ability to see the primary care physician participating in an ACO, contraindicates efforts to provide accountable care.”

CHIME told CMS that patients who want to opt out of sharing claims data should be required to see a primary care physician not affiliated with an ACO, or that healthcare expenditures for these patients should not be counted against an ACO under shared savings payments.

“Technology will no doubt play a prominent role in the success of any ACO. The amount of data and information exchange between ACO participants will be enormous,” Bill Spooner, senior vice president/CIO at San Diego-based Sharp HealthCare, said in a CHIME media release. “But as the person responsible for lining up those data points, CIOs are really worried about patient data opt-out provisions. We think the simplest answer is to remove patients from ACO participation if they refuse to share their data.”

CHIME, in its comments to CMS, also objected to a requirement that 50% of an ACO’s primary care physicians meet all meaningful use standards for electronic health records by the beginning of the second year of the ACO’s agreement with CMS. “From both patient management and business perspectives, CHIME feels it would not be necessary for an ACO’s PCPs to meet all MU requirements. Similarly, CHIME sees no need for CMS to specify some minimum level of EHR MU performance for the hospitals participating in an ACO,” CHIME said.

Pam McNutt, senior vice president/CIO of Methodist Health System in Dallas, and chair of CHIME’s Policy Steering Committee, said concerns raised in the letter to Berwick speak to the complex technical implications of CMS’s Shared Savings Program. As hospitals look to participate, they will depend on CIOs to understand how ACOs meet the data collection and reporting requirements. We urged CMS in our comments to avoid prescribing technology, such as requiring meaningful use, instead allowing ACOs to make determinations based off their business needs and patient populations.”

CHIME also asked CMS to:
  • Reconsider the proposed use of 65 performance measures in the first year of the ACO program. “CHIME also believes that CMS is underestimating the difficulty of the proposed data validation process,” the letter to CMS said.

  • Align performance measures across similar or related programs and outline a more consistent approach for measuring quality improvement for other programs that overlap. David Muntz, senior vice president/CIO at Dallas-based Baylor Health Care System and chair of CHIME’s Advocacy Leadership Team, said that healthcare organizations want to develop and monitor “the right performance measures” to improve healthcare delivery, “but some of the proposed performance measures for ACOs seem to be duplicative or unrelated to broader ACO tenets.”
  • Scale back expectations for health information exchange to give healthcare organizations more time to gain experience with the use of exchanged patient data in care delivery. “These proposed regulations portend a level of functional health information exchange and technology adoption that may be too aggressive for deployments in January 2012 and not yet ready for effective deployment,” CHIME said in its comments to CMS. “We believe this issue could be better handled by allowing ACOs to determine their own technology needs, given their market and their patient population.”

The letter was signed by CHIME CEO/President Richard A. Correll, and CHIME Board Chairman Lynn Vogel, MD, who is also vice president/CIO at the University of Texas, M.D. Anderson Cancer Center.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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