A colleague sent me a very interesting article from Vision Monday <–read more here. It is a must read if you want to do more then refractions for the rest of your professional career!
Here below are some of the excerpts from this lengthy but informative article. Note that the important statement is that in every state every ACO or PCHM is different and to be IN you must be part of a Network. Private practices that are not part of networks will be very unlikely to be included!
Big National networks will be of little benefit as they cannot coordinate or work with local ACOs and they will not have the connections or the ability to deal with each to its needs as each will be unique, as you will see from the excerpts from the article below…………
“One of key things a provider has to do to be on ACOs is to be able to share information,” confirmed Jim Grue, OD, director of health policy integration with OD Excellence. “This is accomplished through approved communications—Direct and Connect. To achieve meaningful use stage 2, electronic health records software has to support Direct messaging. This enables any EHR to share consolidated continuity of care documents with any other EHR via secure communications and then be able to take apart that document to retrieve the information it contains. With one click of the mouse I know exactly what’s wrong with the patient without having to ask the patient.” It is through health information exchanges being established on the state level through which medical professionals will securely share information.
When health care is driving toward team-based delivery, what happens when you’re not on that team?” asked EyeCare Advice’s Jackson, implying that optometrists need to join in or be leftout. By definition, ACOs are groups, organizations of specialists led by a primary care physician or hospital system. You can no longer stay alone on “eyecare island,” as Jackson puts it in his book, The Value-Driven Eye Care Game.
This also means that although it is possible but challenging to do so as a sole practitioner, joining an ACO will most likely be as a networked group of optometrists, according to most of those involved who spoke with Vision Monday.
The market for ECPs will change,” Edward Barnwell, president/founder, KDD Health Solutions, told Vision Monday. (Essilor hired KDD to write The Eye Care Professional and Emerging Models in the Reform of Healthcare.) “Those willing to embrace change and initiate organizational competencies will be successful. There are very few independent community pharmacists,” he said as an analogy. “If the independent ECP does not adopt some of these strategies, they will be subject to risk.”
“Someone is not going to do this for you; you have to do this for yourself,” added EyeCare Advice’s Jackson. Unlike legislation favoring optometrists, often promulgated by national and regional optometric associations, joining an ACO will be leftup to each and every optometrist. “Looking back at Medicare parity legislation, everything changed at the stroke of a pen, but health reform is not like that,” continued Jackson. “If you are not learning where you fit in the rubric of ACOs, you are going to be left out.”
With reducing costs while improving care among ACO’s tenets, optometrists who contribute to these goals are better positioned to join them. One way to achieve this is by showing that they can raise patient quality measurement scores.
For example, the Physician Quality Reporting System (PQRS) combines incentive payments and payment adjustments for reporting information such as e-prescribing, exchanging health information, implementing electronic health records, and tracking results through clinical data registries. Beginning in 2015, the program penalizes those who do not satisfactorily report data on quality measures.
“The performance of an ACO-like system indicates the importance of the ECP in helping achieve improved quality of care and the awarding of millions of dollars in shared savings and PQRS incentives,” stated the KDD white paper on Emerging Models in the Reform of Healthcare commissioned by Essilor. “ECPs participating within a network of over 600 physicians in a 2005 Physician Group Practice Demonstration Project involving Medicare fee-for-service beneficiaries at St. John’s Health System (now Mercy Clinic) in Springfield, Mo., identified early symptoms of diabetic retinopathy and other disease in otherwise asymptomatic patients. The organization did not achieve its threshold for savings in the first two years of service but did record 100 percent of its quality measures in the same period. Since then it has achieved millions in CMS shared savings each year while significantly improving patient satisfaction scores.”
Because of optometrists’ ability to influence the diagnosis and continuing care of certain chronic diseases, such as glaucoma, diabetes, hypertension, and others, optometrists can contribute to the elevation of these important Star, HEDIS, and other measures. “There are several quality metrics that ECPs are in a unique position to help with ACOs,” said 4Patient- Care’s Guterman, citing diabetes, glaucoma and hypertension among them.
“Optometrists must understand these systems are being formed around big ticket items such as hospital stays,” said the AOA’s Third Party Center’s Montaquila, “but at about 1 to 2 percent of the total health care spend, eyecare is way down the list. It’s important to show this cost savings that results from emergency room diversion.”
One of the reasons the jury is still out on whether ACOs will be effective and successful is because some detractors view them simply as a rehashing of the decades-old HMO models or just another form of managed care organization. “When I first started practicing in the early ‘90s, talk of capitation was the best way for practices to establish themselves and make money, assuming you kept costs under control and visits normal,” said Dan Dietrichs, OD, formerly of the National EyePA Coalition. “It was supposed to be a huge profit margin, but it was a pyramid scheme. Somebody gets all the money and somebody does all the work, but not necessarily the same guy. I’m not sure people want to do more work for the same amount of money.”
ACOs: What You Must Know
• The goals are to improve care for people and communities while reducing costs.
• ACO growth is projected to accelerate.
• Payments will become outcomes based, not fee-for-service.
• Financial incentives encourage providers to work together and reduce costs.
• Evolved from HMOs, ACOs are a different model of coordinated care.
• Both CMS-based and commercial, ACOs come in many forms.
• You need electronic health records to participate in ACOs.
• Networks of ODs will be more attractive to ACOs than sole practitioners.
• ODs must be proactive to be included, or risk being left behind.
• ODs must prove their value to ACOs by improving quality and reducing costs.
• A major role for ODs will be identifying and managing chronic diseases.
• ACOs are local and regional, not national, different in every state and every community.