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Will Healthcare ACO Incentives Be Consumed by Software and Vendor Expenses When It’s All Said and Done?

Posted Apr 06 2011 12:03am

Most have not made it through Meaningful Use yet and enrollments are slated to start with CMS on April 18th for providers to log on and establish an account.  You can read more about registering and reporting your meaningful use here.   I think this was the one Northrop built with their contract for $34 Million last year to build. Defense contractor interest in building software has also picked up due to cuts in defense contracts. 

Healthcare providers can verify that they have met the requirements for meaningful use of electronic health records starting April 18, when the Centers for Medicare and Medicaid Services launches its online attestation service. 

To receive a Medicare incentive payment, providers must confirm that they have fulfilled the certified technology and quality objectives for meaningful use through the CMS Web-based Medicare and Medicaid EHR Incentive Programs Registration and Attestation System.”

As it has been stated all over the web Health IT services will be required for an ACO to function as you will need business intelligence, perhaps more billing modules more auditing, more this and more of that.  The HIE folks are ready to sell you and they are the big money makers in all of this too.  As I reflected in the title depending on what is spent, software could eat up your incentive money.  The health insurance companies are all in here too with some like United and Aetna owning a lot of Heath IT companies and wouldn’t surprise me in time to see their next efforts to go after consuming some of the medical record vendors.  With connectivity they are going to have to work with many and more than likely the medical record vendor will have administrative costs built in there too so they win again with collecting there as well. 

IT’S ALL ABOUT THOSE ALGORITHMS IF YOU WANT TO COLLECT.

So you have done all of this, got the software up and going and business intelligence information is just starting to roll in and boom, well cut backs at the hospital or you find out your hospital is getting purchased or worse case, is ready to file for bankruptcy.  Now what? 

In the meantime a new physician’s group for 3 departments has come in and they have their own cost accounting software that now needs to integrate and oh by the way, the ICD10 converter software needs adjusting as the billing is not mapping to the old ICD9 and you still have a lot of unfinished SNOMED items to work on, as well as sweating your next joint commission visit and you find out the Medicare auditors have found some issues too, so can you do all of this and still capture that incentive?  Well you have already gone out on a line of credit for all of this, admissions are down and you need to have this incentive to pay everyone. 

As the CIO of this hospital everyone wonders what’s taking you so long to do all of this?  Of course there are hundreds of other matters and disruptions that will occur along this line too.  You might have a CEO or other executive you answer to that is maybe like the one in this video?  No ACO is out of the box for sure and all is customized.  I just wonder how the ACO movement will go over when we are still tackling meaningful use and how rich “the consultants” will be?  

In the meantime you do find out that now your hospital too has been bought out by a private equity firm that wants their investment back in a few short years and private equity investments are getting to be common place today, so much that they had to create their own non profit group to talk about how to profit, if that is not a current day oxymoron, I don’t know what is…good luck and the new rules are forthcoming complete with all the algorithms to qualify.  Over the last few years we have built ourselves one huge jungle of software that needs to talk and exchange records so it’s that lack of collaboration we have had for so many years that I think lead up to all of this.  BD

How Big Are Private Equity Investments in Healthcare – Large Enough to Create a “Non-Profit” Trade Association To Talk About How to “Profit”

With HHS (the Department of Health & Human Services) announcing its Medicare incentive program for ACOs (accountable care organizations), IT vendors will need to modify their health care platforms to take advantage of the potential savings.

ACOs are groups of health care companies that join together to coordinate care for Medicare patients and earn incentives based on positive outcomes, such as longevity of life, or whether a condition such as diabetes or hypertension has been contained.

The Medicare Shared Savings Program proposes new rules on how health care organizations—whether they're a doctor's office, hospital, laboratory, supplier or long-term care facility—can be accountable for quality of care and share data on patients' treatment.


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