MeaningfulUse and ACOs
Impactsof Meaningful Use and Is the Accountable Care Organization model thesolution
MeaningfulUse and ACOs
Thereport focuses on the effects of the implementation of an ACO modelas system of improving the payment system and improvement of healthcare services. To effectively realize the creation an ACO, theclinical records are to be managed electronically. The Meaningful Usecomes in place to assist in the establishment and management ofElectronic Health Records (EHR).
Therefore,the first step that an ACO requires is a full implementation of EHR. As such, the impacts of establishment of Meaningful Use lie with howefficient the switch from older methods of managing clinical recordsis managed. An evaluation of the impacts of Meaningful Use onpolicymakers, nurses, nursing and patients is provided in this reportto facilitate decision making. The stages of implementing, resourcesand challenges are explained with evidence from literature.
ACOsare the main operating systems of the Affordable Care Act (ACA). Allpatients will see primary care physicians (PCPs) that offer referralsfor any auxiliary medical are the patients may need, inclusive ofvisits to consultants or specialists such as pulmonologists,gastroenterologists, or cardiologists. In a properly managed ACO,both PCPs and specialists would have access to all the lab works,tests, and imaging of a patient hence, making a perfect EHR system acritical section of an Accountable Care Organization (Lim et al.,2014). An EHR, which attains interoperability, would confiscateduplicate services, further decreasing expenses and keeping thepatients happier since they will not have to repeat exams or tests atevery health care entity they visit. In addition, it eliminates theduty of ferrying packets of papers or compact disks containingfragmented records of outside care or diagnostic tests, which isroutine today.
MeaningfulUse has become a standard term in the United States’ health sector.Getting to understand this phrase is of great importance to all thestakeholders in the medical field. The name is derived from the Actformulated by HITECH in 2009. The Act became law, and its aim was toinitiate a process of change from use of paper in communication anddata storage to utilization of electronic means. Apart from datastorage, other clinical operations are also supposed to be automated(Harveyet al., 2014).The act merely advocated the use of electronic means of data storage,the performance of activities and communication in the nursingsector. According to the Act, the electronic data storage systems aswell as other digitalized components of the healthcare industry wereto be used in a more advanced way. The advanced way by which suchoperations are to be carried out gave rise to the term MU (MeaningfulUse).
Conversely,ACOs (Accountable Care Organizations) exemplify a transformingdynamic within the health care system of America where serviceproviders would increasingly be compensated to manage thepopulations` health effectively it is not based on the bulk ofservices they offer. ACOs are formed when groups of medical providers(non-physician providers, hospitals, and physicians, among others)come together and jointly agree to become accountable for the qualityand financial results of distinct populations. The varying models ofpayment shift fiscal risk from the payers towards the providers(Anumula& Sanelli, 2012).In doing that, healthcare experts are steadily encouraged andincentivized to transform the manner in which they are deliveringmedical care with the objective of lowering spending while enhancingpatient satisfaction and quality measures. The models of AccountableCare are adopted by state Medicaid plans, commercial health insurers,and Medicare.
ACOshave been receiving significant attention recently. They are therecent solution in addressing the rising inflation in medical carecosts while also improving the quality of health services. It isclear that implementation of an ACO requires an established modernEHR platform for management of clinical data. In order to address therising costs, it is important to alter the ways in which healthcarecenters are organized in terms of delivery of clinical services andways of payment for services delivered. The kind of organizationstructure that can address the need is ACO.
Statementand Analysis of the Issue
TheMeaningful Use concept rests upon the "five pillars" ofmedical results policy priorities, which include improving carecoordination enhancing public health and population improvingefficiency, safety, quality, and decreasing health variationsengaging families and patients in their health and ensuringsufficient security and privacy protection for confidential healthdata (Rippenet al., 2013).
MeaningfulUse involves utilizing medical records that have been storedelectronically. These records are known as EHRs(Electrical-Health-Records), and they contain a lot of data aboutpatients. The data is collected whenever an individual visits ahealth care facility and is stored electronically. The records, as aresult, contain most of the information that is useful in offeringhealth care to an individual (Harveyet al., 2014).This is because, from the registers, a health care provider is in aposition to access information about the patient`s health history andother aspects without doing much interrogation. Electronic data iseasily accessed just by pressing a button hence, the utilization ofelectronic records in the healthcare sector has increased theefficiency of services in the area.
Thereare many advantages and other several positive changes, which haveresulted from the use of EHRs. Before examining the merits andbenefits of meaningful use, it is important that one understands theconditions set by the Act, which led to the initiation of thetechnological intervention within the medical sector. The EHRs wereto assist in decision-making in health operations since the expertphysicians are capable of making sound decisions concerning medicalinterventions based on past medical information of a client orpatient (Anumula& Sanelli, 2012).In addition, entry of a patient’s data was to be madeelectronically according to the law. The last and most importantaspect of the law is that there would be sharing of data by variousmedical practitioners.
Impactof Meaningful Use
Effects on Nurses
Thereare several implications of EHRs to the nurses and other medicalprofessionals. First, they can never make autonomous decisions basedon knowledge and experience. Instead, their actions and decisions aredetermined by the CDS. It implies that the EHRs have made thementirely independent. Secondly, the process of learning a new methodor way of doing things may be tedious and traumatizing (Jamoomet al., 2013).The fact that utilization of EHRs is a new development makes itrelevant for all medical officers, doctors, and other individuals inthe field to learn the new way of doing a thing. The process oflearning may be cumbersome to some nurses. This is because they get adifficult time learning something new within a short period whilethey are still required to perform their duties as nurses. Some ofthem become emotionally dejected as a result of being forced to learnand implement something new (Rippenet al., 2013).Thirdly, after using the new technology for long, nurses or medicalpractitioners are likely to depend on the EHRs than their knowledgeand practical experience. The result of that will be a loss ofknowledge and skills gained after an extended period of study andwork experience. These implications are some of the indications thatnurses will be influenced negatively by the EHRs.
Impacts on Nursing
Nursingwill be affected negatively by the utilization of electronic records.It is because the change from the old system to a new one will entailthe use of time, space, and resources. The training process willinvolve the use of resources, and many nurses will not be in aposition to serve patients adequately during the training period.That will negatively affect the medical field. The other implicationof EHRs to nursing is that it is associated with a variation in theoperations within a healthcare set up (Harveyet al., 2014).That is because the shift from paper recording and communication to anew system will create a delay in performance of the transactionsbefore the nurses get used to it. The period between the inceptionsof the program to the time, everyone gets used to it will becharacterized by delays in service and changes in general performanceof medical officers.
Impacts on Patients
Wheninformation is stored electronically, it can be accessed by very manyindividuals in case proper measures are not put set to preventunauthorized access. The electronic records used as a result of theimplementation of the meaningful use contain a lot of informationabout the patients. Within the files, there may be some aspects of apatient`s health record, which he or she considers very confidential.Surprisingly, the information will be accessed by a healthcare workerby the click of a button. It is, therefore, evident that privacyconcerns of patients are not catered for in the use new health policy(Rippenet al., 2013).It is likely to make many patients shy off from sharing theirconfidential health information with nurses or other medical officersfor fear of disclosure.
Impacts on Healthcare Policymakers
Theuse of EHRs has resulted in more work for the policy makers. It isbecause the implementation of the program will be an interferencewith the secrecy of patients. To evade that, they should come up withstrict rules governing access to a patient’s personal informationand health records. In addition, they have to develop guidelines forhandling various situations like immunizations against communicablediseases and other health related issues (Zerwekh& Garneau, 2014).The stage two meaningful use regulations still must yet be printed intheir ultimate form, though supervisors are now getting started toconstruct the subsequent stage of the instructions for HER usage. Thehealth committees recently met with different healthcare shareholdersto discuss methods by which stage three meaningful use regulationscan offer additional support for quality enhancements, according toFACB (Federal Advisory Committee Blog). Representatives from theteams mainly discussed methods of leveraging information so as toinform the decision-making of physicians. In addition, the groupsbegan talking about ways of making information “liquid” hence,making it simpler for the healthcare agencies to share data regardingpatients and study from each other. There is yet a long path to gobefore any strict policy suggestions for the stage three regulationsare set.
Impact of Meaningful Use on Workflow
Asa facilitator, one will need to aid their practices to incorporatetheir EHRs in their workflows. EHRs improve healthcare when, forinstance, the standing orders are recorded to mandate nurses andseveral other personnel to perform requests per practice-certifiedprotocol. For example, one research indicated that the reminder toolsof EHR together with the standing orders for immunizations, diabetesmeasures, and screening helped the staff to adopt new duties androles (Anumula& Sanelli, 2012).People can as well aid their practices to utilize their EHR inidentifying the materials of patient education suitable for allpatients e.g. EHRs can be associated with libraries ofeasy-to-comprehend audiovisual and print materials. Informationstored in EHRs, like the preferred language of patients, can be usedfor selecting proper resources.
Furthermore,one can help his/her practices train to use EHR for producing visualdisplays, which can be employed for shared decision-making, actionplanning, and patient education, among others. If an individual`spractices have specific EHRs, which lack full functionality requiredfor supporting the PCMH or Care Model, he/she would need to assistthe profession supplement its capacity of care management (Jamoomet al., 2013).If an EHR cannot identify the patients’ population due tohealthcare services, the practice would need to maintain theregistries, much as they will have to act if they lacked EHRs.Registries are patient databases with specific conditions,procedures, or diagnoses. While EHRs contain patient-specific dataabout every patient experience at a medical center, registries aresubgroups of the patients within the EHRs.
Ingeneral, a record is easier to utilize to track the outcomes andprogress of patients than an EHR. Even though registries can bestandalone applications, they are frequently populated by EHRs toavoid recording essential items of data twice. The report types EHRsgenerate are core to aiding a practice actively track operationalsignals meet meaningful use, accreditation, and regulatoryrequirements and manage patients (Limet al., 2014).Based on the report type, it may be at the provider or practicelevel, but beginning with the latter is a perfect way of identifyingred flags, which need drilling downward the provider level.
Beforevarious programs that support EHRs can be installed and used,computer hardware will be purchased and installed in varioushealthcare centers. In addition, training of implementers of theprogram has to be done. The training will be aimed at enabling thenurses and other medical officers to implement the programefficiently.
Inits proposed regulations, CMS (Centers for Medicare and MedicaidServices) delineates two main areas for open comment: its extensivestrategy of staging meaningful use by phases and the particularmethods, which would be applied for meaningful use`s first stage. Forthe success of the federal venture in meaningful use, it has torecognize the broad range of abilities of various health experts whenit comes to executing EHRs. The plan of CMS accordingly offers astaged methodology to meaningful use, which comprises three stagesover 2011-2015 with every step reflecting rising rigor andexpectations. The staged method recognizes the necessity for themedical IT infrastructure to advance to back the increasinglyambitious objectives.
Thethree stages include stage 1, stage 2, and stage 3. STAGE 1concentrates on the collection of health information and using thedata to track the key clinical conditions, facilitate medication anddisease management, communicate about the health care needs, andreport the critical public health and quality information. On theother hand, STAGE 2 centers on the exchange and use of data toenhance the care of specified patients, and STAGE 3 focuses on thepromotion of systematic advancements through promoting developmentsin safety, efficiency, and quality (Harveyet al., 2014).In addition, stage 3 supports systematic progress by developingdecision support for nation-wide high priority conditions offeringpatient access to the self-control tools, enhancing populationhealth, and facilitating the access to comprehensive data ofpatients.
Associatedwith every stage is a range of standards for meaningful use, whichmedical professionals have to meet in order to satisfy the stage andget incentive compensation. The current proposed regulation of CMSdetails the measures for Stage 1, which began operations in 2011. Theprinciples for Stage 2 started working in 2011, and that of Stage 3began in 2013. To obtain the incentive payments for Stage 1, CMSnecessitates that medical providers meet about two dozen criteria ofprovider usage of medical IT functionality and report the clinicalquality measures. The rules differ suitably by the type of providerand if the providers get their meaningful use inducements throughMedicaid or Medicare. From the purchaser and consumer point of view,the criteria and timeline suggested by CMS are appropriate andattainable.
Aslower process will continue allowing the patients to face needlessharm, fail to meet Congress intent, and propagate systeminefficiencies. CMS seeks to streamline the Medicaid and Medicareprograms of meaningful use. CMS recommends that the policies ofMedicaid meaningful use employ the definition of Medicare ofmeaningful use however, states can request the approval of CMS toexecute the measures of meaningful use above the minimum.Nevertheless, some there are some apt variations (Zerwekh& Garneau, 2014).The providers of Medicaid are eligible to acquire larger total paysover a long duration, they can get more “up-front” backing to aidpay for the initial expenses, and they experience less stringentcriteria of performance in the first phase.
Soas to leverage the prospective of an EHR mechanism`s ability toenhance the quality of data, and to comprehend the limitations aparticular system may have, it is important that a HIM expert has acomprehensive understanding of their discrete EHR systemfunctionality and a broad knowledge of EHR functionality. Datastrategies as well as an efficient data quality plan that includesdata integrity procedures have to be in place for ensuring maximumquality of data. Some matters to consider handling in a general planfor the quality of data improvement and monitoring, in a meaningfuluse program, include patient identification, corrections, andamendments, and copy functionality.
ACCOUNTABLE CARE ORGANIZATION
Severaldescriptions define Accountable Care as the provider-led model, whichemphasizes quality outcomes and cost. At the institutional level,entities that pursue Accountable Care embrace fiscal accountabilityfor a population’s health care requirements. Moreover, they managethat population’s care across the medical care continuum. Inaddition, ACOs harmonize care among the providers and use theemerging health IT to enhance quality and cost (Limet al., 2014).Nevertheless, Accountable Care may be simplified into aresult-oriented payment and delivery system reform attempt, whichfocuses on reduced costs and better outcomes. A more extensivedescription based on different literature reviews, interviews withACO-type facilities and ACOs, and organizational analysis hasstretched the definition of Accountable Care to encompass threecrucial elements. These components include goals for reducing costsand improving the quality of health care, process-level systems forhelping attain desirable results, and structural readjustment forenabling process-level transformation. The last two elements for aneffective ACO model are vital to accomplishing the first constituent.To attain Accountable Care, medical care providers have to apply allof these conceptions to their organizational practice.
Asuccessful way of driving behavioral change is creating incentives.In the ACO model, care providers alter conducts based on therecognition that they are liable for quality and cost results of apopulace. Financial accountability of a population of patientsincentivizes health experts to shift care practices in order tofacilitate wellness hence, optimizes the chance of attainingimproved quality of care and reduced declined expenses. WithinAccountable care, the providers enter in a contractual commitment orseveral other risk-based pacts with insurers to take on monetary riskrelated to the outcomes and care of a described patient population(Zerwekh& Garneau, 2014).Although the risk amount ranges from just incentive pay toupside-only dividend agreements and full capitation contracts andeven more detailed bundling, eventually, the financial structure ofan ACO promotes the provision of higher quality, lower cost care.
Twoconventional approaches for facilitating monetary responsibility areeither a full or partial capitation or a shared savings agreement. Inshared savings models, the ACOs are remunerated for spending belowexpected costs through sharing in portions of the earned savings.ACOs might as well take part in shared risks, whereby they assumefinancial fines for spending beyond projections. In general, sharedsavings agreements start with mere-one-side risks and slowly move tothe two-sided risks as the entities acquire more experience in AC(Accountable Care). The models of capitation differ in the sense thatthe company bears complete downside and upside risk for using aboveor below a negotiated rate of capitation. To date, several MedicareACOs have just adopted one-sided fiscal risk, without trying tochange to the two-sided risk approach.
Process-Level Healthcare Management
Refiningthe delivery of care also requires a change of behavior, especiallyby the healthcare providers who are delivering care. In order toamend the process of care delivery to be more patient-oriented, ACOsusually redirect their systems of care management. Redirection ofsuch systems is aimed at overseeing the clinical care provision,coordinating that health-care across the spectrum of medicalservices, and efficiently managing the health of the populationthrough executing suitable HIT (health information technology)(Rippenet al., 2013).Coordination of healthcare enables professionals to help patients inthe management of health through directing them to appropriate carecontexts along the care continuum.
Theefficiency of Accountable Care approach can be evaluated by assessingthe development of the movement, as well as the financial and qualityoutcomes of new ACOs. Even though this model is somewhat nascent,continual progress and moderate quality and fiscal successes proposethe potential for AC to transform the healthcare delivery structureof the United States.
Growth of Movement
Since2010, the ACO marketplace size has steadily amplified, not just inthe total number of entities, but in covered AC lives and the totalamount of ACO agreements. Even though the growth rate has decreasedin the recent times, the continuous ACOs` pervasion into the medicalmarketplace exemplifies a considerable movement towards payment anddelivery system reform. By January 2015, there were around 744 ACfacilities, 404 of which were having government agreements (Limet al., 2014).The remaining twenty ACOs have not stated the specifics of the ACcontracts. In average, these ACOs encompass more than twenty millionlives as a portion of their payment arrangements of Accountable Care. Early growth drivers of the movement may be attributed to anamalgamation of conscientious recognition of the necessity to improvedelivery of care alongside the desire of seeking first-mover benefitin new contract types.
Financial and Quality Outcomes
Furtherdevelopment of AC movement is reliant on the current ACOs` success.CMS has lately released first-year quality and fiscal outcomes forthe MSSP Accountable Care Organizations and preliminary second-yearinformation for the Pioneer ACOs. In addition, some commercial ACOshave published monetary and quality findings, though these data isharder to compare because of inconsistencies in the paymentsettlement types and the metrics of quality. By November 2014, theACOs of Medicare in both the MSSP and Pioneer initiatives togetheryielded 877 million USD in savings, 460 million USD of which wasreverted to the ACOs as a portion of their contract of shared savings(Harveyet al., 2014).Although the cost reserves are positive, the savings are uneven amongpartakers.
A Sector Slow to Transformation
Ofcourse, there are some potential drawbacks. Some people claim thatthe execution of fresh technologies and healthcare coordination areproving more challenging than previously perceived. To help in thisundertaking, CMS founded a bundled initiative of payment and paid alot of cash as a portion of the program of Meaningful Use to motivatedoctors to integrate EHRs into their practices (Zerwekh& Garneau, 2014).In addition, several physicians are very busy today. It isinsufficient to encourage doctors using financial inducements tocommunicate among themselves entirely. The deed of alerting the wholecare team should become routine, which in an ideal structure would beas normal as taking good physical and history.
Hazard of Capitation Approach
Theother apparent problem with Accountable Care Organizations is thatmany of them depend on the capitation approach between coverage firmsand healthcare experts. Capitation operates by giving fixed amountsper patient to practitioners for offering healthcare throughout setintervals. This might give doctors the temptation of offering lessmedical care to decrease cost hence, increasing their annualprofits. Luckily, though, there are fiscal incentives for avoidingsuch kind of act (Jamoomet al., 2013).As a way of focusing on quality instead of quantity, medicalfacilities, and physicians that fulfill pre-determined measures ofperformance are paid for their success, principally being reimbursedfor keeping the patients healthy.
Risks of Monopoly
Somefear that creating ACOs would generate healthcare corporations withpowerful negotiation abilities, which far surpass those of theprivate medical care customers. This is a legal issue for any sectorwhen one organization can attain the majority of the marketplaceshare. However, the emphasis on quality is something exclusive to theACO approach. Even if health systems exist as the only providers in aparticular geographical region, which usually happens, the continuousfocus on performance must be capable of keeping the company in check.
Very Few PCPs
Thesuccess and development of ACOs might as well be restricted by theoverall number of PCPs who have been allotted the main post of ACOcoordinators. Such physicians examine patients and refer them toexperts as they see appropriate. Most individuals think that thereare very few PCPs to create and manage the number of Accountable CareOrganizations for the current populace in need (Harveyet al., 2014).Reasonably practical solutions like loan repayments for doctors inunderserved regions have been attempted, but the greatest effect hasbeen caused by mid-level health-care providers, like nursepractitioners and physician assistants, filling the duty.
An advancement to a Fragmented Structure
Overall,ACOs are much-required advancements for the new fragmented mechanismthat concentrates less on quality than volume. Record keeping,appropriate payment for services offered, and improved communicationis the basis of the new ACO model. ACOs help in reducing medicalmistakes, removing duplicate services, and providing fiscalincentives for demonstrating high quality, patient-oriented care(Zerwekh& Garneau, 2014).The model is not a complete solution, though it is a stride in thecorrect direction.
Recommendationsand Insights on Meaningful Use
Mostof the stage three-measure updates include updates to goalsincorporated in stage 2 Meaningful Use. Most have been improved withmore challenging provisions so as to raise the anticipated advantageto healthcare enhancement that emerges with fulfilling the measures.For instance, presently in stage two meaningful use qualified expertshave to give a minimum of 50% of their patients the capacity to viewonline, transmit, and download their health data. Such is only doablewithin four business daylights of the data becoming accessible to thehealthcare provider. Clinics are needed to offer access to 50% of thepatients in one-and-a-half days of discharge (Harvey et al., 2014).All providers should make sure over 5 percent of patients observetheir records. The present stage two also measure to record thedemographics of patients in the health record for over 80% ofexceptional patients found throughout the reporting duration has beenenhanced. In stage two, qualified hospitals should have EHR recordsthat are capable of recording the preferred language, race, birthdate, sex, and ethnicity. The stage three recommendations require theEHRs of hospitals to register this information as well: The patient’schosen method of communication, which is a telephone, e-mail, orletter Disability Status Industry codes and occupation and Genderidentity or sexual orientation. As such, the study of meaningful useprogram gives the insight to understand the importance, objectivesand aims of EHR in a hospital setting. Further, it permits the simpleunderstanding of hospital operations and flow of commands through theelectronic accomplishment of tasks.
TheCMS is attempting to make the AC model a more captivating choice formedical care providers. ACA launched the Medicare Shared Savingsinitiative to enhance coordination and to induce specialists andseveral other healthcare organizations to take part in an ACO.Involvement in all of these initiatives is presently voluntary.However, it is evident that the Accountable Care and value-basedmodel they represent is the future, both in the private and thepublic payer realms. In fact, commercial insurers have alreadyestablished their ACO versions (Anumula& Sanelli, 2012).The meaningful use and adoption of licensed EHRs underpin the entireaccountable care concept. These mechanisms should act as the datasources for several clinical quantity measures, which ACOs have toreport to CMS annually. That information runs the scope fromrecording the preventive medical measures like mammography screeningsand immunizations to tracking populaces at higher risks ofhypertension, chronic conditions, and diabetes.
Anumula,N., & Sanelli, P. C. (January 01, 2012). Meaningful Use. Ajnr.American Journal of Neuroradiology, 33, 8,1455-7.
Harvey,H. B., Gowda, V., Gazelle, G. S., & Pandharipande, P. V.(February 01, 2014). The Ephemeral Accountable Care Organization—AnUnintended Consequence of the Medicare Shared SavingsProgram. Journalof the American College of Radiology, 11,2,121-124.
InZerwekh, J. A. G., & In Garneau, A. Z. (2014). Nursingtoday: Transition and trends.
Jamoom,E., & National Center for Health Statistics (U.S.),.(2013). Physicianexperience with electronic health record systems that meet meaningfuluse criteria: NAMCS Physician Workflow Survey, 2011.
Lim,M. C., Chiang, M. F., Boland, M. V., McCannel, C. A., Wedemeyer, L.,Epley, K. D., Silverstone, D. E., … Lum, F. (September 01, 2014).Meaningful Use: How Did We Do, Where Are We Now, Where Do We Go fromHere?. Ophthalmology, 121, 9,1667-1669.
Rippen,H., Scott, D. M., Hartley, C. P., & American Medical Association.(2013). Aguide to achieving meaningful use: Leverage your EHR to redesignworkflows and improve outcomes.