In March 2010, while Congress was reviewing the Patient Protection and Affordable Care Act, one media outlet hired a speed-reader for an on-air segment to thumb through the bill's 2,074 pages. His eyes spent slightly more than five seconds on each page while anchors repeatedly asked, "What does it say?" The speed-reader tried to summarize the heart of healthcare reform to viewers, licking his fingers and tossing the read pages on the floor.
More than a year later, many hospital leaders may sympathize with the speed-reader — except they're not going to a commercial break. The pace of change has revved up, and leaders are expected to understand, manage and deliver change at an alarmingly rapid rate. Here, Brian Yeaman, MD, CMIO of Norman (Okla.) Regional Health System, discusses the dilemmas providers face with one component of healthcare reform: Pioneer Accountable Care Organizations.
"I don’t know how to add hours to a day"
After CMS' proposed rule for accountable care organizations received considerable backlash, it launched the Pioneer ACO program. It is designed to offer more flexibility (such as prospective beneficiary assignment) for 30 integrated systems that are prepared to begin coordinating Medicare patient care in as soon as October rather than Jan. 2012. Presented as a sort of Plan B, the program was tweaked to appear more lenient, except for one thing: it moved even faster than basic ACOs. The initiative was introduced in early June, but the deadline for applications is Aug. 19.
In May, a new study estimated that ACO start-up costs could climb to $26.1 million — a significant increase from CMS' original estimate of $1.8 million. Healthcare experts often speak of ACO costs in monetary terms, but the model involves costs in time as well. "We're trying to adapt Meaningful Use, HIE and accommodate big changes like ICD-10. Despite the fact that we're one of the most well-positioned health systems to begin work on the Pioneer ACO project, our resources are overwhelmed," says Dr. Yeaman.
The overwhelmed resources extend beyond technology or analytics, since changes will rattle nurses' and physicians' workflow and burden their ability to maintain high-quality care. Dr. Yeaman says some physicians have asked whether the computer system is now an additional patient. "We've gotten feedback from physicians saying, 'You have to enable us more or buy us more time in a day if we need to put all these components into a computer system.'"
Time spent measuring performance may detract from patient care
Pioneer ACOs were presented as a lower-risk option, but Dr. Yeaman says the obstacles are still the same, and providers are expected to overcome them in an overwhelmingly short period of time. "The question becomes are we going to spend all of our time measuring? If we're doing so much measurement alone, how do we go back and change our workflow and not hurt our financial performance?" By leaving little time to adjust and adapt, ACO demands force providers to juggle the organization's quality of care, finances, patient safety and employee satisfaction — a balancing act that is anything but low risk.
Hospital leaders may be familiar with this conflict. Slightly more than 33 percent of hospital executives say it is extremely likely their hospital will become part of an ACO, but only 6.8 percent believe ACOs will improve quality and efficiency, according to a recent survey. These contrasting numbers show the philosophy behind ACOs might not be the reason some providers jump on board.
An exciting but terrifying time
The debate over ACOs no longer pertains to their value or philosophy — it's rare to find a provider who doesn't support high-quality care and reduced costs. The debate is now over how fast hospitals can maintain the required changes while maintaining quality care and financial performance. "It's an exciting time, but it's terrifying nonetheless," says Dr. Yeaman. "Changing these systems is not as easy as it sounds. When you go too fast, you create potential gaps in communication, and the workflows aren't aligned with the mission," he says.
Essential Primer: Pioneer ACOs and Proposed Advance Payment Initiative
CMS Unveils New ACO Model For Advanced Organizations, to Start in Summer
More than a year later, many hospital leaders may sympathize with the speed-reader — except they're not going to a commercial break. The pace of change has revved up, and leaders are expected to understand, manage and deliver change at an alarmingly rapid rate. Here, Brian Yeaman, MD, CMIO of Norman (Okla.) Regional Health System, discusses the dilemmas providers face with one component of healthcare reform: Pioneer Accountable Care Organizations.
"I don’t know how to add hours to a day"
After CMS' proposed rule for accountable care organizations received considerable backlash, it launched the Pioneer ACO program. It is designed to offer more flexibility (such as prospective beneficiary assignment) for 30 integrated systems that are prepared to begin coordinating Medicare patient care in as soon as October rather than Jan. 2012. Presented as a sort of Plan B, the program was tweaked to appear more lenient, except for one thing: it moved even faster than basic ACOs. The initiative was introduced in early June, but the deadline for applications is Aug. 19.
In May, a new study estimated that ACO start-up costs could climb to $26.1 million — a significant increase from CMS' original estimate of $1.8 million. Healthcare experts often speak of ACO costs in monetary terms, but the model involves costs in time as well. "We're trying to adapt Meaningful Use, HIE and accommodate big changes like ICD-10. Despite the fact that we're one of the most well-positioned health systems to begin work on the Pioneer ACO project, our resources are overwhelmed," says Dr. Yeaman.
The overwhelmed resources extend beyond technology or analytics, since changes will rattle nurses' and physicians' workflow and burden their ability to maintain high-quality care. Dr. Yeaman says some physicians have asked whether the computer system is now an additional patient. "We've gotten feedback from physicians saying, 'You have to enable us more or buy us more time in a day if we need to put all these components into a computer system.'"
Time spent measuring performance may detract from patient care
Pioneer ACOs were presented as a lower-risk option, but Dr. Yeaman says the obstacles are still the same, and providers are expected to overcome them in an overwhelmingly short period of time. "The question becomes are we going to spend all of our time measuring? If we're doing so much measurement alone, how do we go back and change our workflow and not hurt our financial performance?" By leaving little time to adjust and adapt, ACO demands force providers to juggle the organization's quality of care, finances, patient safety and employee satisfaction — a balancing act that is anything but low risk.
Hospital leaders may be familiar with this conflict. Slightly more than 33 percent of hospital executives say it is extremely likely their hospital will become part of an ACO, but only 6.8 percent believe ACOs will improve quality and efficiency, according to a recent survey. These contrasting numbers show the philosophy behind ACOs might not be the reason some providers jump on board.
An exciting but terrifying time
The debate over ACOs no longer pertains to their value or philosophy — it's rare to find a provider who doesn't support high-quality care and reduced costs. The debate is now over how fast hospitals can maintain the required changes while maintaining quality care and financial performance. "It's an exciting time, but it's terrifying nonetheless," says Dr. Yeaman. "Changing these systems is not as easy as it sounds. When you go too fast, you create potential gaps in communication, and the workflows aren't aligned with the mission," he says.
Related Articles on Pioneer ACOs:
Will Pioneer ACOs Come to the Rescue, or is the Government Rearranging Deck Chairs on the Titanic?Essential Primer: Pioneer ACOs and Proposed Advance Payment Initiative
CMS Unveils New ACO Model For Advanced Organizations, to Start in Summer