2. Overestimating the ability to use EHR.
The financial support of CMS definitely eases the pain but Shortell said the implementation of EHR can be very disruptive to a physician practice with the negative impact stretching out for six months to a year. He cautioned that a successful EHR launch requires the ongoing staff support of physician or nurse, software upgrades, and regular staff training. What's at stake is the ability to report on the cost and quality metrics required for shared savings success.
3. Overestimating the ability to report performance measures.
Even with EHRs it will be a challenge to collect, analyze, and report the 65 performance data measures that may be required of ACOs.
4. Overestimating the ability to implement standardized care management protocols.
The goal of disease protocols is to eliminate anything in the care delivery process that doesn't add value. For protocols to work, clinicians must be involved in their development, data must exist to assess the protocols, and the protocols must be able to be tailored to individual patients. Everyone in the ACO needs to use the protocols, which should be adjusted over time as more information becomes available. This process needs to be managed by someone and not just left to chance.
5. Failure to balance the interests of hospitals and physicians.
The jury is still out on whether new incentives like shared savings will mitigate or exacerbate the strain that usually exists between hospitals and physicians.