Providers get D-minus on the ACO test

Some provider groups are falling short on key clinical processes when treating pneumonia and heart failure, according to vendor evaluations designed to test their ACO readiness.

Vendors say there are ways to have ACOs working right

It is the kind of grade that students are afraid to show their parents – the dreaded D-minus. Barely a notch above flunking, the grade is emblematic of poor performance.

In this case, the “teacher” issuing the low grade is Scott Weingarten, MD, president and CEO of Los Angeles-based Zynx Health and the “students” are approximately 100 provider groups striving to become Accountable Care Organizations.

As part of an evaluation process designed to test their ACO readiness, Zynx audited selected provider groups on their use of key clinical processes when treating pneumonia and heart failure. The clinical processes are standardized clinical best practices accessed at the point of care via an electronic health record and are proven to reduce mortality, hospital readmissions and costs.

In demonstrating how the $36 billion in federal funds for EHR implementation have been utilized to date, the groups were given a collective grade of D-minus. Weingarten said he wasn’t surprised by the low grade and offers a simple explanation of why the providers didn’t do better:

“A lot of health systems focused on going live and mistakenly considered it to be the ultimate outcome,” Weingarten said. “When some hospitals think about whether they have all the necessary clinical decision support built in, they acknowledge they may not, but they think they can go back and correct it. And they don’t get back to it as quickly as they like. They focus on ‘going live’ as the end point and it takes a while to go back and focus on achieving the best results.”

From September 2011 through February 2012, participating hospitals were rated by five EHR vendors and their scores fell squarely into what would commonly be recognized as D territory, ranging from a low of 55 percent for heart failure to a high of 73 percent for pneumonia.

The good news for those low-grade earners is that it’s “a mid-term grade, not the final exam,” Weingarten said. “There are concrete things they can do. We have given them feedback on how to improve things and the response has been positive.”

‘The smart middle’

Greenwood, Colo.-based TriZetto has coined a term called “the smart middle” to describe the processes necessary to making an ACO function properly. Payment model changes are key, says Jeff Rideout, MD, senior vice president of cost and care management and chief medical officer for TriZetto, meaning that providers and their partners must coordinate and enable the workflow, care redesign, payment and revenue cycle process throughout the system across the healthcare continuum.