Sunday, June 10, 2012

CMS' and The Possible Obsolescence of Its Versions of the EHR, PCMH and ACO

Let thousands bloom
After reading this Huffington Post (HuffPo) article by National Physicians Alliance board member Ricky Choi, the Disease Management Care Blog is worried.

According to Dr. Choi, sometime last week, the White House hosted a meeting of national physician leaders to talk about the Affordable Care Act.  HHS Secretary Sebelius was there along with other CMS administrators.  The conversation focused on electronic health records (EHRs), the patient centered medical home (PCMH) and accountable care organizations (ACOs). 

The DMCB is not worried about another Cabinet member blurring the line between policy and election-year political grandstanding.  It is not concerned that naive ACA supporters are unwittingly being used to promote the Administration's health reform nostrums.  It is not surprised that this flattering article seemed only fit for liberal HuffPo and is destined to reinforce the biases of an already committed base. It is not wondering about a curious commitment to care approaches that still are not conclusively backed up by a critical mass of peer-reviewed evidence. Finally, the DMCB isn't shocked that it was not invited to the White House.

Rather, says the DMCB, it's worried that this is all the White House has.  A precious day of CMS leadership attention spent in recycling stale EHR, PCMH and ACO acronyms and jargon with a fawning circle of fellow ideologues? What gives?

While the CMS' EHR's meaningful use program continues, health care technology is evolving away from fixed desktops and mainframes toward mobile smart devices, apps, the cloud and social media. The transition is bound to shift doctor's and patients' highly personalized management of information in ways that we haven't thought of. 

CMS' "PCMH Ver. 1" entails a wholly contained primary care provider team reimbursed with a monthly fee.  In the meantime, other health systems and insurers are already figuring out how to simultaneously out and insource team members depending on local resources and patient risk. 

CMS is just getting its ACO pilots and programs off the ground. In contrast, commercial insurers launched a host of "accountability" initiatives years ago. Many are focused on a single clinical domain (such as avoidable emergency use, patients who are high risk, or post-discharge readmissions) and are highly flexible and expandable.

The distinctly modular approach to health IT, medical homes and provider-insurer risk transfer certainly contrasts with CMS' plodding one-size-fits-all and top-down planning.  While a thousand commercial sector flowers bloom, CMS risks presiding over demos and pilots that could become obsolete before the the data collection has been completed.  Why aren't they meeting about that?

Last but not least, the Administration seems to be putting all of the ACA's eggs in the EHR, PCMH and ACO baskets. If they don't work out, it would further undermine the brand of the star-crossed Affordable Care Act.

Image from Wikipedia

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