Information Interoperability: Successful Positioning For ACOs

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michael_mytychPressing issues, among them the ever-shrinking Medicare Physician Fee Schedule and the threat of further imaging cuts wrought by the debt-ceiling agreement signed on August 2, might be looming larger than accountable-care organizations (ACOs) on radiology providers’ radar screens.

It is incumbent upon savvy players within the radiology sector, however, at least to consider how the advent of such organizations will affect them and what building blocks will be required in order to make the transition to an ACO model. ACOs are essentially networks of health-care providers (including various combinations of hospitals, physicians, and ancillary-service providers) contracted by Medicare and other payors to care for members of a defined patient population.

The ACO concept itself is not new; a failed initiative undertaken by the Clinton administration called for the establishment of similar networks of providers, called accountable health partnerships. “This time, things are a bit different,” according to Michael J. Mytych, a principal of Health Information Consulting in Hartland, Wisconsin. He notes that Medicare, in light of its financial woes, will continue to push the ACO concept. Other payors will follow suit, which will create the need for members of the radiology community to position themselves for alignment with some type of ACO.

In addition, Mytych points out, there remains the public perception that the US health care system is flawed and cannot continue down its current path. Even if the Patient Protection and Affordable Care Act undergoes modification or is somehow repealed, this perception will not go away, and legislators will push for some sort of change.

Mytych says that centralized repositories for data collected by practices will replace disparate systems for data storage and will form the base of support needed by all entities opting to participate in one or more ACOs. “ACOs are going to assess patient-care providers in all specialties for their ability to provide a wealth of identifiable data to track and manage patients across care settings,” Mytych says. “Unless those data are organized into logical models and stored—or warehoused—in a way that facilitates query and analysis, providers will be unable to deliver.”

Moreover, Mytych notes, data maintained within such repositories will come from multiple sources, including electronic medical records, PACS/RIS, and many other information systems. “Having all of this information in one place will facilitate the process of performing sophisticated analytics,” Mytych states. For example, radiologists using a centralized data repository should be able not only to pinpoint an unusual number of repeated procedures, but also to discern why they were repeated—and whether that reason was a lack of information or care coordination among referring physicians and imaging providers.

In a similar way, practices with central data repositories in place will be able to analyze whether their current staffing levels jibe with utilization patterns, as well as how overall financial and patient-care performance are trending in relation to past patterns.

“Practitioners may not like the term ACO because they are not accustomed to the idea of being accountable to anyone other than colleagues within their own organizations—and, of course, patients,” Mytych concludes. “The concept is here to stay, though, and those practices with a streamlined data backbone stand to fare best under it.”

Julie Ritzer Ross is editor of RadAnalytics.com