Group Practice Reporting Option (GPRO) Tool and Accountable Care Organizations (ACO)

The CMS proposed regulations on Accountable Care Organizations (ACO)s was released on March 31, 2011. These rules give a glimpse of how the government is planning to coordinate the electronic health record (EHR) meaningful use incentive program with its plans for ACOs. In an article published in the New England Journal of Medicine, Donald Berwick, MD, administrator of the Centers for Medicare and Medicaid Services, said the creation of ACOs is one of the first delivery-reform initiatives that will be implemented under the health reform passed a year ago. But this program also builds on some existing incentive programs and tools for quality reporting.

The Physician Quality Reporting Initiative (PQRI) established a financial incentive for eligible healthcare professionals to participate in a voluntary quality reporting program. By reporting on a minimum of 3 measures on a specified group of patients, a physician can earn a bonus payment of 1% on all of their Medicare billing for one year. In 2011, CMS renamed PQRI the Physician Quality Reporting System (PQRS). For 2011, there are 194 quality measures and 14 measures groups in the PQRS, which can be reported to CMS by physicians and other caregivers in hospitals or physician practices. Last years rule for the Medicare Physician Fee Schedule had an impact on both PQRI and eRX Incentive programs. The recently released proposed rule on Accountable Care Organizations will make use of the same reporting tools that PQRS uses. The CMS website for the PQRS is here: https://www.cms.gov/PQRS/01_Overview.asp

Beginning with 2011 Physician Quality Reporting, a group practice consisting of a single Taxpayer Identification Number (TIN) with 2-199 individual eligible professionals or individual national provider identifiers (NPIs) can submit data on quality measures to qualify for an incentive payment. If it is determined that the group practice satisfactorily reports data on Physician Quality Reporting measures, the practice will be eligible for an incentive payment equal to one percent of the practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges.

The GPRO II reporting mechanism is via claims. If the group does not have an applicable measures group to report via claims, the practice can report that measures group via a qualified registry. The reporting requirements for GPRO II are determined on a tiered basis depending on the group's size. Groups selected to participate in GPRO II will use the Physician Quality Reporting System Measure Specifications Manual for Claims and Registry Reporting of Individual Measures and the Physician Quality Reporting System Measures Groups Specifications Manual for the respective reporting year.

In the first year of the new ACO program announced by CMS ACOs will use a new ACO GPRO tool based on the data collection tool currently used in the PQRS. In subsequent program years through additional rulemaking, we would expect to refine and expand the ACO measures to enhance our ability to assess the quality of care furnished by ACOs participating in the Shared Savings Program and expand measures reporting mechanisms to include those that are directly EHR-based. The tool would allow ACOs to submit clinical information from EHRs, registries, and administrative data sources required for measurement reporting. One very interesting section of the proposed rule on ACOs is:

In July 2010, HHS published final rules for the EHR Incentive Programs. Included within the final regulations were certain clinical quality measures for which eligible professionals and eligible hospitals are responsible. We have noted in Table 1, the proposed Shared Savings Program quality measures currently included in the EHR Incentive Programs and will continue to further align the measures between the two programs. Given that we have proposed in Section II.E.6 that at least 50 percent of an ACO's PCPs are "meaningful EHR users" as that term is defined in 42 CFR 495.4 by the start of the second Shared Savings Program performance year in order to continue participation in the Shared Savings Program, our intent is to develop the capability of the GPRO web-based tool to interface with EHR technology, such that EHR data could directly populate the ACO GPRO tool with the required quality data. As we intend to further align both the Shared Savings Program and EHR incentive program through subsequent rulemaking, we anticipate that certified EHR technology (including certified EHR modules capable of reporting clinical quality measures) will be an additional measures reporting mechanism used by ACOs under the Shared Savings Program for future program years.

Obviously, there will continue to be alignment, not only between the reporting requirements for ACOs and the EHR Incentive Program requirements for meaningful use, but also the Standards and Certifications Criteria for EHRs in the succeeding phases of the program. I imagine that the interface between the EHR and the ACO GPRO tool will become a very important part of healthcare innovation for the future...


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Sebelius and Blumenthal HIMSS 2011 Conference Keynotes

At the annual HIMSS conference, Secretary of Health and Human Services Kathleen Sebelius and National Coordinator of Health IT Dr. David Blumenthal discussed the progress made in healthcare IT.

While much has been accomplished, Sebelius warned the crowd of over 30,000 attendees about the long road ahead. In terms of health IT adoption, “there’s already a gap between large urban hospitals and small rural ones,” she said. As she pointed out, 30% of primary care physicians (PCPs) use an EHR system today. That represents progress since only 20% of PCPs used an EHR system two years ago, but it still means that seven in 10 primary doctors do not have electronic health records.

"The energy and creativity and commitment to improving health are a positive sign," Sebelius said. "Eventually, we'll see hospital after hospital clear out their file cabinets. For future generations, jokes about doctors' handwriting will be a thing of the past."

Moving forward in health IT, Secretary Sebelius stressed the need for engagement in health reform, a push for technological development, adoption of EHRs by small practices, and provision of health IT across all populations regardless of racial background, geographic location, and socioeconomic status.



Dr. Blumenthal delivered a positive message on the progress of health IT stating, "Meaningful use is no longer a hope or a theory -- it is a working, operating program -- as reality." In his keynote address, Dr. Blumenthal also provided an update on the progress of the electronic health record (EHR) incentive programs, regional extension centers (RECs), health IT training programs, and EHR modules.

The main topics of Dr. Blumenthal's keynote include the incentive programs, the national infrastructure designed to support the adoption of EHRs, and patient health information (PHI).

"Meaningful use provides us a way to set expectations and goals, a blueprint for what info should be available, to whom and when, in support of an improved health care system and improved health," Blumenthal said.

Direct Project ~ Specifications and Compliance

Doug Fridsma, M.D., Ph.D. is the Director of the Office of Standards and Interoperability in the Office of the National Coordinator for Health Information Technology (ONC). He is currently on leave from the Department of Biomedical Informatics at Arizona State University and from his clinical practice at Mayo Clinic Scottsdale. On Monday, March 21, 2011 he announced the Direct Project specifications are achieving widespread adoption and gave a glimpse into what's in store for the future of this project.

Important points in this announcement are:

• There are significant commitments by key national players (states and health IT vendors) that bode well for universal adoption for the Direct Project.
• The pilot projects and specifications related to IHE profiles and transitions of care demonstrate how the Direct Project is so much more than secure email.
• The Direct Project specifications (final) and compliance (draft) documents are now available.

Two key events are also coming up:

• On Monday March 21 at 1 PM ET, Arien Malec will be presenting the Direct Project update at the National eHealth Collaborative NHIN University course.
• And on March 29, the Direct Project will be on the agenda for the HIT Standards Committee meeting.

The post also pointed out that over 60 healthcare and health IT organizations, including many state based and private sector health information exchanges, leading IT vendors, and several leading integrated delivery systems, have planned support for the Direct Project. The full current and growing list is available here. Dr. Fridsma said:

"This broad swath of support for the Direct Project represents approximately 90% of market share covered by the participating health IT vendors. With over 20 states participating in the project, including many of the largest states in the country, nearly half of the total U.S. population can now benefit from the Direct Project’s growing integration into the national health IT ecosystem. Growing participation with the Direct Project will alleviate a healthcare system awash in a sea of paper and faxes."

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Reflections on HIMSS 2011

This year the annual 2011 Annual Healthcare Information and Management Systems Society (HIMSS) Conference & Exhibition broke all previous attendance records. 31,225 attendees showed up in Orlando, Florida for the conference between Monday February 21 to Thursday February 24 with pre-conference events beginning Saturday night. Total professional registration at this year’s conference also saw an increase with 14,639 registrants, compared to 13,672 registrants in 2010. But aside from record breaking crowds and the sheer size of the conference, the things that struck me were some of the themes illustrated in the content. I will explore some of them in future posts, and believe there was some great catalyst for innovation springing from this years conference.

One of theses themes was health information exchange (HIE). The HIE Symposium held on Sunday before the conference kicked off explored how HIEs are leveraged to meet the 'new era' challenges of leveraging HIE in achieving Meaningful Use and reaching patient care quality goals. There were sessions from experts and state legislators, a panel on federal initiatives and many other valuable educational opportunities. There was also a Town Hall session focused on the intersection of HIE with Accountable Care Organizations, Healthcare/Payment Reform and Insurance Exchanges. There were at least 16 educational sessions after the symposium touching on HIE.

Of course, the Interoperability Showcase also continued this theme with numerous educational opportunities and presentations from industry leaders. There were tours scheduled throughout the conference and this was one of the more important areas of the exhibit hall (although tucked away off to the side). There were also demonstrations from each of the Direct Project pilots getting under way, and many announcements from vendors during the conference on their involvement in the project. Just take a peak at the Interoperability Showcase Use Case Selection web pages for a taste what attendees had the opportunity to experience.

Another important theme was the topic of the Accountable Care Organization (ACO). The Leading from the Future: A Thought Leadership Event on Accountable Care Organizations sessions were outstanding and there were also numerous focus groups and roundtable breakfasts on the topic. Aneesh Chopra brought the subject up at the Venture Fair presentations and HIT X.0 and one thing he started the Intel sponsored breakfast roundtable is still ringing in my ears: "By January 2012 you will see these organizations and new payment models so you had better be prepared." I am increasingly convinced that without the technical infrastructure in place to enable new payment and delivery models, healthcare in this country will continue to drag down our economy and keep us from improving quality.

The other theme that emerged from this conference was the explosion of social media. Every where you looked you saw exhibitors drawing attention to their Facebook, Twitter and YouTube pages, and Keith Boone even managed to have his Twitter handle printed on his official conference badge :-) But the new Social Media Pavillion at HIMSS was a huge hit. There were many excellent presentations, and despite being somewhat difficult to find, the center was a hubub of acticity. Throughout the conference, attendees used social media to share their observations, comments, photos, and videos. You can see the enthusiasm from activity on the HIMSS page on Facebook, discussion groups on LinkedIn, the HIMSS Channel on YouTube and tweets all over Twitter! The educational sessions, panel presentations, and fellowship and sense of community in the social media center was a definite highlight of this years conference. I'm really excited about what next year may hold...


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