ACO's have a lot of requirements in terms of data submission to meet guidelines.
The discussion above is fascinating since all of the views above are true. One day EMRs will be more granular and AC may be in some trouble, but that is a long way off and technology may develop to pull the granularity out of text.
AC should be able to provide what they need. More than likely they are not getting raw data from multiple EMRs because each would have to have customized data templates. More likely they have to have reports set up a certain way and those EMRs have been shown to do it in the fashion they want (or at least that was what was promised.)
People always underestimate AC because it is more like "the Little Engine that could."
But take a step back. Start with simple economic model.
ADVANTAGES
What is the financial incentive to join the ACO? Ideally, make this per patient.
The way the ACO's are set up makes them voluntary. What are the advantages for patients to join the ACO. What makes it THAT much better than regular Medicare (MCR). The advertising that has been sent to seniors emphasizes their need to share data and that scares seniors.
How many patients are currently in the practice with MCR and what percentage are likely to change. This is a very difficult analysis given the above paragraph, but, for the sake of argument assume 20%.
DI
DISADVANTAGES
How much does MegaBucksEMR cost IN TOTAL (program, set up, hardware, training and LOST PRODUCTIVITY.)
Will it change your billing system and what are the associated costs with this?
Are there other factors in the ACO that would also cost money? These might include meeting time (lost productivity,) entry fees, employee time for training to the new rules
ADVANTAGES - DISADVANTAGES = PROFIT
It the profit worth the hassle factor?
I'm sure there are other factors on both sides I have not taken into consideration. But if you assume 1000 MCR patients and the ACO gives an extra $200 per patient (VERRRY generous assumption!!!)
1000 x .2 (percent that may convert to ACO) = 200
200 x $200 per patient is $40,000
Cost of MegaBucksEMR will be put at $50,000 plus $10,000 in hardware and 20% decreased productivity for A YEAR (it will probably start worse and improve, but most providers are not as productive as with AC.) Further assume that the gross revenue in the practice is $500,000.
$50,000 + $10,000 + (.2 X $500,000) = $160,000
While theoretically this would be a 4 year break even point, there are ongoing losses in productivity and probably decreased satisfaction since AC is easier to use and manage. If they were factoring in MU return that would help IFF you were not using an EMR already, but that is a wash, since is has been easier to achieve MU from AC than most EMRs as well.
Finally most EMRs are cloud based, do they want to house their data in the cloud. If they should wish to change EMR's are they willing to move the data (and at what cost.) ARE THEY WILLING TO EXPORT DATA FROM AC TO THE NEW EMR AND ABSORB COST? This would be another disadvantage item.
ACO's require tighter hospitalization guidelines as well as willingness to follow disease guidelines and oversight. Like many things in medicine, nobody wants to actually pay PCPs for their management. Otherwise we would earn the big bucks.
