Right Place, Right Time, Right Patient. Right Provider?

Tom J. Northey, MSM

Tom J. Northey gives us the second half of his ACO  and Audiology post today.  In his current forecast of what’s ahead for Audiologists in the changing healthcare market place, he’s introduced us to the ACO (accountable care organization) model, electronic medical records (EMR), and health information exchanges (HIE).  

It’s time to take those acronyms and own them.  Mr. Northey gives Audiology two lists to get us on track, headed in the right direction.  Thanks again to him for taking the time to explain and point the way.

Fig 1. ACOs in the US last year and on the horizon.

Reprisal of How Things Stand

In other healthcare provider environments, EMRs exist that meet certification standards and thus are eligible to participate in HIE exchanges and ACO models.

There are lots of ACOs and more on the way (Fig 1).

Audiology today has no such certified EMR system.

If Audiology does not get such a system, it can’t participate in ACO models.

 

Will Audiology be the ACO Provider?

The answer depends on a number of factors and If/Then outcomes. Audiology needs to consider these and act accordingly.

• ACOs most likely won’t include a redundancy of services, i.e., multiple specialists, especially multiple audiology practices.
• ACOs depend on a narrow or defined network of providers{{1}}[[1]]Think hospital, primary care, specialists, long-term care/nursing home, behavioral health, other ancillary providers.[[1]] who can all exchange data and agree to certain quality outcomes/standards.
• ACOs are paid based on the quality of the care delivered. Contract leverage with payers (Medicare or commercial) equates to the ability of the ACO to come under the negotiated contract rate per patient. Yes, we are returning to capitated payments/pmpm) and sharing in the savings.
• If a provider or practice continues to fail to meet those quality standards, thereby incurring cost to the ACO,) they will be removed from the ACO.
• If a provider cannot exchange patient data at the standard required for the ACO, then that provider won’t be part of the ACO.
• The FTC is relaxing or waving laws that historically prevented exclusive referrals, revenue sharing et al. to make way for these new ACA{{2}}[[2]]Affordable Care Act.[[2]] endorsed healthcare models.

If audiologists do not engage in a strategic road map for participation in these new ecosystems then they may find themselves reduced to the retail side of hearing aid sales.

The upside is potentially significant: a secure referral stream from PCPs and specialists and a collegial seat on the patient’s care team.

How to Begin Planning

First, embark on a study of ACOs and specifically ACOs forming in your community. Start with your local hospital or primary care physician group.

Second, reach out to your state or regional Health Information Exchange (HIE vendor){{3}}[[3]]For example, here is the website for the Alaska eHealth network, with links for participants and providers.[[3]] and ask them how you can get connected via Direct. The Direct Project is a secure (encrypted) email pathway to secure a Direct email address for direct secure message (DSM).

The third step will take the most time and the most creativity. We hope to discuss this step more in future articles. It will require thinking around these questions and preparing a plan:

• What will be my personal or practice level value statement for audiology services in the continuum of a patient’s healthcare?
• How will my practice demonstrate that it can receive and transmit the requisite data to be a contributive ACO partner? (Direct email will be part of this solution).
• What collaborative, care management activities can I contribute (demonstrate) that will assist in driving down costs? For example, better hearing will be essential to medication adherence, care team/nurse interaction, cognitive function, patient engagement and adherence to care plans.
• What potential volume hardware savings can I provide (Pro Forma) to the ACO based upon number of units sold? What might a “share back” look like in compliance with FTC exemptions?

Formulate and be ready to present your plan to key ACO stakeholders earlier rather than later. By that I mean be part of the ACO discussion in your community before the ACO becomes defined and operational with its final list of participants.

Thanks Tom!

The future is laid out.  Some Audiologists will heed your advice by banding together, learning new skills, acquiring software and technology, and gaining acceptance into the ACO club, or whatever comes after it in the emerging healthcare world of coordinated, cost-contained, collaborative care.

Other Audiologists will stay the course for reasons of their own: they are stand-alones, they lack the resources to align with more progressive practices, or they are nearing retirement.  Those Audiologists will find themselves in a retail world where cost containment is always the name of the game as consumers shape the Demand curve.

As usual with Economics, there are no right answers, just answers based on individual preferences of providers who will be making their practice choices based on their Utility and Budget Constraints.  Speaking of which, look for a two-part series in November on preparing practices for sale as part of retirement planning.

Tom J. Northey, MSM, founded the first Audiology IPA in Colorado (ACI Network) and negotiated its sale to Starkey in early 2008. Since then, he has held management positions in Health Information Exchange (HIE) and Accountable Care Organizations (ACOs). Currently, he is Executive Director of the California Rural eHealth Information Network (CAReHIN.org).

images courtesy of right time rehab and  Oliver Weyman