Tag Archives: ACO

Annual Meeting Focuses on Echocardiography and Its Future

©Ekko/Wikimedia Commons

Multimodality imaging is among the highlights of this year’s American Society of Echocardiography meeting, which starts on June 30 at the National Harbor, Maryland.

The society is pushing forward the concept, looking at different diseases and integrating different kinds of imaging such as echo plus nuclear, Cardiac CT, or Cardiac MR, in order to get the best diagnoses, said Dr. Melissa Wood, co-director of Massachusetts General Hospital Heart Center Women’s Heart Health Program, Boston, and the chair of ASE Public Relations Committee.

“This isn’t just about echo, it’s also about all the other imaging techniques that are out there and how we can work together and deliver the highest quality of care,” said Dr. Wood in an interview. “It’s also about what’s superfluous, and what we don’t need to do.”

On the policy front, Accountable Care Organizations will be in the forefront during the meeting. Dr. Wood said that the speakers will address how “ACOs affect those of us who read echos and do them, and how they affect practices.”

Echocardiography will also leave this planet for a bit during a symposium. ASE president Dr. James Thomas has been in the past actively involved in doing research with the space station and helping pick the right echo machine to go up there, said Dr. Wood. “There’s substantial interest in microgravity and the heart, and how heart changes its function in space. It’s something that’s very unique, and there are lessons that can be learned from that, and that experience will be somehow useful in our clinical practices, whether it’s specific type of research techniques or specific types of information that are gained in that environment.”

Echocardiography is the second most commonly ordered test after EKG, according to Dr. Wood, and with the aging population, the use of the test is likely to increase.

“I see echo take off more because of this concern about heart failure being an epidemic. Echo as a way to diagnose heart failure before it becomes profound,” she said. And given the appropriate use criteria, “we’re tying to moderate the reasons echos are ordered, so they’ll continue to be fairly reimbursed by third parties and CMS (Centers for Medicare and Medicaid Services),” said Dr. Wood.

You can find the meeting’s program here. And be sure to check our coverage on ecardiologynews.com.

By Naseem S. Miller (@NaseemSMiller)

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Filed under Cardiovascular Medicine, Health Policy, health reform, Practice Trends

ACO Details Are Out: The Policy & Practice Podcast

After much anticipation, the Centers for Medicare and Medicaid Services finally released the final rule on accountable care organizations. As physician and hospital groups were initially wary of ACOs, CMS said they’ve considered the suggestions and the rule was adjusted accordingly. Among other changes, interested physicians will now have more time to get an  ACO up and running.

Dr. Don Berwick discusses the future of Medicare. Courtesy the Bipartisan Policy Center

Meanwhile, other parts of the new health law haven’t has the same success. The administration has cancelled CLASS, the law’s long-term insurance program, calling if financially unsustainable.

The decision has given GOP lawmakers ammunition for arguments against the ACA.

For details on that and much more, listen to this week’s Policy & Practice Podcast.

–Frances Correa (@FMCReporting)

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Help Is on the Way for Primary Care Doctors (Wink, Wink)

Help is on the way “very soon” for family physicians, internists, and pediatricians in the form of a final rule for accountable care organizations (ACOs).

Based on extensive feedback on the proposed ACO rule, changes are coming that primary care physicians are going to like, Dr. Nancy Nielsen said.

The preliminary  rule  “was met with – how shall I say? – an underwhelming response by the medical community,” said Dr. Nielsen, Senior Advisor of the Center for Medicare & Medicaid Innovation established as part of Centers for Medicare and Medicaid Services (CMS) by the Affordable Care Act.

“We have a few code words we have to work out here so I don’t get into trouble, but you get what I am trying to say,” Dr. Nielsen said at the American Academy of Family Physicians Congress of Delegates. For example, if I tell you ‘it has been suggested to us,’ that is REALLY important and it may be coming out, but I can’t announce anything yet,” said Dr. Nielsen, an internist and former president of the American Medical Association.

Regarding ACOs, Dr. Nielsen said, “Very soon the final rule will come out. Very soon. CMS has listened to the feedback:”

“It has been suggested to us that 65 quality measures are way too many.”

“It has been suggested to us that the mechanism for the shared savings ought to be done differently.”

“And it clearly has been suggested to us that hospitals have the ability to come up with the capital to start an ACO, but it’s really tough for doctors. So it has been suggested to us that we give advanced payment. I am here to say that very soon you will see that, and very soon you will like what you see.”

Although doctors have always been accountable for the care of patients, now they also will be accountable for resource expenditures, and the Center for Medicare & Medicaid Innovation plans to help, Dr. Nielsen said. There will be new expectations and new tools given to primary care physicians. “I will tell you that never once in my 23 years of practice did I see data showing me what it cost when I ordered an x-ray. Do you know what it costs when you write a prescription for an antibiotic? Do you get that data? No, you have never seen that.”

“But you must help us achieve this … when the [internal] warfare within the house of medicine begins,” Dr. Nielsen said. “I have a pet peeve. It really makes me crazy when people talk about people who do primary care as ‘primary care physicians’ and all the other docs as ‘specialists.’” She said that family physicians, internists, and pediatricians should stand together and say ‘We are specialists, just like you are specialists. We have a critical role to play and we need to have the tools to help us play that role.”

“Stay tuned. A lot of things you are going to, like, have been suggested to us.”

Dr. Nielsen’s comments were streamed live on the Internet during the congress and are available as archived video.

–Damian McNamara

@MedReporter on Twitter

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Filed under Blognosis, Family Medicine, IMNG, Internal Medicine, Pediatrics, Physician Reimbursement, Practice Trends

A Sales Pitch for ACOs

There’s been a lot of criticism of the accountable care organization (ACO) concept lately, or more precisely, the federal government’s proposal to share Medicare savings with qualifying ACOs starting next year.

That proposed regulation, which was released at the end of March, outlined how qualifying ACOs could earn additional payments if they could save the Medicare program money. But there were plenty of caveats. The Centers for Medicare and Medicaid Services proposed that ACOs meet a certain threshold of savings before they could get any money back. And the rule also set rigorous standards for quality of care, requiring ACOs to meet 65 quality measures.

Since the rule came out, many physicians’ groups have criticized the proposal, saying that it made it too difficult for physicians to get involved. The steep up-front investment in technology, workflow redesign, and staffing, coupled with the uncertainty of achieving savings, would be too much for many practices, they argued. And even officials at the Cleveland Clinic, a health system that many viewed as a prime candidate for being a successful ACO, have said they see major problems with the Medicare plan for ACOs as it stands today.

Dr. Don Berwick. Photo by Laurie Swope.

Earlier this week, Dr. Don Berwick, the CMS administrator, defended the direction his agency is headed with ACOs. In a speech to participants at an ACO learning session sponsored by CMS in Minneapolis, Dr. Berwick said ACOs are one big step toward building a different, better health care system that promises to improve care for individuals and the population as a whole, all while lowing cost. But he admitted that it was a “very, very difficult step.”

There will be growing pains for everyone in the health care industry as they move forward with ACOs, he said. For instance, physicians, nurses, and other health care providers will have to learn to work together in teams to care for patients with chronic illnesses. Physicians working in the operating room and in the intensive care unit will need to truly embrace checklists. And everyone will have to grow used to their electronic health records and disease registries. Prevention, he said, must become an “obsession.”

And beyond those cultural changes, there are many other obstacles. There’s stranded capital, Dr. Berwick said, and a workforce that is underinvested in primary care and not well suited to supporting continuity of care. There are immature metrics to measure what goes on in an ACO and limited capacity to use the metrics that do exist, he said. Plus, there’s the problem that most of the money paid out by Medicare and private insurance is for the volume of care delivered, not the quality of care received.

But those aren’t reasons to shy away from ACOs or other fundamental reforms of the health care system, Dr. Berwick said. To help overcome some of the obstacles to the success of ACOs, CMS’s Innovation Center is holding learning programs like the one in Minneapolis. They are also experimenting with the idea of advancing funds to promising ACOs that lack start-up money. And they are working to get better data out of the Medicare system. “We intend to help,” Dr. Berwick said.

How many ACOs are likely to emerge next year when the program begins? Dr. Berwick said he doesn’t know, but he’s hopeful that officials at CMS can craft a final rule that will attract many organizations. He urged physicians, hospitals, and others to consider taking a leap of faith, despite the risks. “I ask you to think again about what you risk if, while the world shifts around you, you choose to stand still.”

So does Dr. Berwick make a convincing case for ACOs and the government’s shared savings program? Let us know what you think.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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Filed under Health Policy, health reform, IMNG, Physician Reimbursement, Practice Trends, Primary care

SGR: The Three Most-Hated Letters in Medicine –The Policy & Practice Podcast

Most physicians would be happy if they never had to read, hear about, or discuss Medicare’s Sustainable Growth Rate, or “SGR” ever again. Alas, it looks like years of attempts to get rid of that formula, which dictates physician fees for Medicare, have come to naught yet again.

Courtesy of Ohio AFL-CIO Labor '08 Flickr Creative Commons stream

Congressional negotiators agreed last week to give physicians a reprieve from the 21% cut due to take effect on June 1, but instead of a replacement for the SGR, they simply said they’d punt on the issue for the next 3 years or so.

Physician groups and even the White House expressed exasperation, yet again, and it was all captured on this week’s installment of the Policy & Practice podcast.

Also included in our 3-minute rundown: a first look at the accountable care organization, or ACO.

Take a listen and let us know what you think:

—Alicia Ault (on Twitter @aliciaault)

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Filed under Health Policy, health reform, IMNG, Physician Reimbursement, Podcast