Eye Care Communications, Part 3

Continued from Part 2 ... 


This week, we are looking at EMRlogic's National Eye Care Communications Project, understanding what this project is and why we need it. We began on Monday looking at it through the eyes of a new and very important pilot project, the Comprehensive Primary Care (CPC) Initiative. On Wednesday, we discussed the importance of pilot projects, and of ECP involvement in them. Today, we look again at the big picture: primary care and the Medical Home model.

Medical Home or Medical Community?

Nationally, one of the challenges that the Office of the National Coordinator of Health Information Technology is facing is the resistance of large health systems to implement DIRECT, as these communications provide equal access to all health care providers in communicating with all other health care providers. The exchanges set up by health systems are primarily designed to funnel patients into their system rather than create equal access to patients. This phenomenon is resulting in a new term in the healthcare literature and media. 


The new term differentiates the Patient-Centered Medical Home model, which is structured around communications through a closed exchange, and alternatively introduces a Patient-Centered Medical Community model, which utilizes DIRECT communications with equal access for all health care providers. It is a primary goal of the NECC Project to ensure that local eye care providers are aware of this distinction and to encourage participants to influence the creation of a medical community that includes independent providers, especially independent eye care providers. 


To be continued ... 


Alistair Jackson, M.Ed.
Jim Grue, O.D.

Eye Care Communications, Part 2

Continued from Part 1 ... we are looking at the National Eye Care Communications Project, understanding what this project is and why we need it. We began on Monday looking at it through the eyes of a new and very important pilot project, the Comprehensive Primary Care (CPC) Initiative.


Two Levels of Involvement

There are two levels at which providers can participate in the CPC Initiative: direct involvement at the primary care level and indirect involvement at the secondary care level. The primary care level is, obviously for Primary Care Physicians. This is the participant role for which PCPs must apply, show eligibility and ultimately be selected. However, ECPs can also be involved indirectly. Indirect involvement means an interactive support role for the PCP, helping her or him understand DIRECT and becoming a partner with whom to exchange patient health information. We believe that by eye care providers being involved in the process from the very beginning, two things will occur.  First, the abilities the eye care provider brings to the primary care physician can actually make the physician a more qualified candidate for team delivery of care and, therefore, more likely to be accepted as a team participant.  Second, if the primary care physician is selected for participation, it will position the eye care office to be selected for inclusion in the care team, coordinated by the primary care practice.

Pilot Projects

The reason we see so many pilot projects throughout the transformation of  health care is that nobody knows how exactly the new connected-care and coordinated-care relationships should be structured. If we knew it already, there would be no need for pilot initiatives or incentives. Two things that we do know from the pilots to date are that, first a provider must be utilizing a certified EHR in order to be part of a team and, second, each provider must have the ability to share patient health information electronically.  Beyond this, there is a set of eligibility requirements that the primary care physician must meet in order to apply – and the local eye care provider can help!  

How can the ECP help the PCP? Many primary care physicians are using certified EHRs but have not been sharing patient health information electronically. So, the eye care provider can actually work with the physician to help implement that capability and serve as a test office once they have set up their communications.  This is an important issue as many local physicians are only aware of exchange communications capabilities within large local health systems. Many are not even aware that one of their communications alternatives is through DIRECT. Again, the eye care provider can actually assist the primary care physician in becoming more knowledgeable about this alternative. 

Additionally, pilot projects are put together with a lot of flexibility on the local level so they can be structured to meet the needs of the local community.  How they will be structured occurs largely at the local level.  Input of the local ECP is important early on as the individuals structuring the pilot may not even be aware of what an ECP can bring to the table, or the value that the ECP can add to the team.  The most effective time to be involved is in the formative stage where you can influence the process the most. The most important question you must ask yourself is whether or not the pilot project or the care team is going to be structured ideally for your office without your involvement.  If you think that may not or will not happen, then you know what you need to do. 


To be continued ...


Alistair Jackson, M.Ed.
Jim Grue, O.D.

Eye Care Communications, Part 1

EMRlogic has launched a National Eye Care Communications Project. This week's posts are dedicated to explaining what this project is and why we need it. We'll look at it through the eyes of a new and very important pilot project, the Comprehensive Primary Care Initiative.

The National Eye Care Communications (NECC) Project is a collaborative platform allowing providers, working in cooperation with their state associations and other professional groups, to share their experiences. The NECC Project emphasizes projects, activities and capabilities destined to affect independent eye care statewide and nationwide that must be supported at a grass-roots level. We offer the Project as an adjunct to local activities, a roadmap that clarifies the end game of health care reform and connected care. 

For several years, the health care media has been full of news about federally-driven and sponsored initiatives intended to lay a foundation for the future of health care. Much of that news has gone unnoticed by providers at a local level. As some of these important projects, the Beacon Community Program for example, draw to a close we are seeing the emergence of new pilot projects at the state and local levels. One such new initiative is the Comprehensive Primary Care (CPC) Initiative, a multi-payer initiative in AR, CO, NJ, NY, OH/KY, OK and OR, fostering collaboration between public and private health care payers to strengthen primary care. It is critical that independent eye care providers understand the pivotal role of the primary care physician in the transformation of health care and, correspondingly, the role of the ECP and other specialist providers in the team-based care delivery model. Understanding this relationship is the key to the successful future of independent eye care. The CPC Initiative gives us a clear window into this vital pilot project.

The Comprehensive Primary Care (CPC) Initiative 

The CPC initiative is one of many coordinated-care pilot projects shaping team delivery of care and participation in shared savings.  CPC, like every other team delivery model, is based on team members sharing electronic patient health information. For this reason, the NECC project emphasizes first and foremost that independent eye care providers must be equipped, both conceptually and technologically, to share and communicate electronic patient health information. The national standard for this kind of communication is DIRECT. The DIRECT standard was established by the Office of the National Coordinator and is offered by a variety of Health Information Service Providers (HISPs) throughout the country.  Since communicating electronically via this national standard is a pre-requisite for participation in the CPC Initiative, it is better for the local provider to have implemented this capability already, rather than wait to start once the primary care physician seeks to qualify as a CPC participant.

Learn more here about the Comprehensive Primary Care Initiative. Pay particular attention to the shared savings opportunity. The fundamental concept behind team delivery is that the quality of care will increase and the team will find ways to decrease the cost of delivering care. Conceptually this makes sense, but in practical terms, you need to be positioned to share in the savings. Shared savings is what makes team delivery work. Otherwise, for the healthcare providers, all savings that the team generates are lost income. The shared savings program repays directly to the providers 85% of the savings that the team creates. You will not share in these savings if you don’t position your practice correctly and get involved with care teams.


To be continued ...

Alistair Jackson, M.Ed.
Jim Grue, O.D.

The Tipping Point Problem

Thought leadership has its challenges, a big one being the tipping point problem.


In these early days of electronic communications between eye care and primary care, we're facing the same problem as the poor guy who had the first fax machine. Or the first phone. Who do you fax to? Who do you call? Or a more recent analogy, how about the first users of e-prescribing? How often did they (or you!) query a patient only to find no data? Today, it's rare to find an empty record.


In these scenarios and others like them, inventors, innovators and early adopters must look forward in anticipation of the tipping point, the day when an idea reaches critical mass. The electronic sharing of Protected Health Information is an idea whose time has not yet come. Is it a good idea? More than that, it's a fantastic idea! Are there detractors and obstacles. Yes, there are. Will we push past the barriers? Absolutely.


We've reached the tipping point on e-prescribing, wouldn't you agree? Despite some numbers out today* showing only 20% attestation in the ambulatory market, I believe we've reached critical mass on EHRs. (This percentage counts neither the hospitals nor the many providers who have adopted EHRs but not yet attested to MU.)


Remember, EHRs are not an end in themselves. It's not about legible exams; it's about sharing and communicating. Communications is the next step after EHRs, the qualifier to gain access to team-based care and bundled payments. In that game, we're at the early adopter phase. Most states and health systems are still thinking internal communications. Therefore, we're busy creating state HIEs, in many cases closed empires. That's not the end game either. We'll get to open systems and inter-state communications. For better or worse, people travel and need health care where they go, and families span the continent. That the part that the Office of the National Coordinator understands very well. And that's the reason for the Direct Project.


Interested to see how we're progressing toward the tipping point for DIRECT communications? Check out an interesting map here. And while you're looking, read up on the Direct Project.


Alistair Jackson, M.Ed.


* EMR and HIPAA, June 20 - Meaningful Use EHR Breakout by Percentage. Click here to read. 

Beat your patients to PHRs!

While at an aforementioned meeting in Washington, DC I met a tech from Microsoft HealthVault. Part of our demonstration showcase meant sending a secure message to the patient, so I was curious to learn what I didn't know about HealthVault. As you might expect, that conversation opened up a whole new world. 

While Microsoft doesn’t market HealthVault as a PHR per se, they do offer it as a ...


“... free online service that stores your health records in a central location, then lets you use the information with apps to manage health conditions, create fitness plans, prepare for doctor visits... 

Keep health records for every member of your family, even pets.
See conditions, medications, and scanned copies of medical documents at a glance.
Prepare for emergencies:

• Access your records from any internet connection—great for travel or emergencies. Create an emergency profile for each member of your family. 
• Print the profile as a wallet card or page-sized sheet. 
• Include an emergency access code so the profile can be accessed online."

Do you think your patients might be interested in this whole new world? And the essential question: have you opened up this whole new world? When your patients start asking you about Personal Health Records and whether or not you can send them electronic copies of their health information, will you be in familiar or unfamiliar territory?

If you haven't already done so, visit HealthVault and, above all, create your own account. If you're in Canada, HealthVault is offered through Telus Health Space. Wherever you are, you owe it to yourself and your family, your patients, your practice and your profession ... and since we're on the p's, maybe even your pets! ... to be ahead of the curve on PHRs.

If you're a Direct Provider, meaning you have registered for a Direct address and certificate, you already have what it takes to send secure messages to your patients. Patients will get a secure Direct address if they sign up for HealthVault.  Health Information Service Providers  will be offering patients secure addresses as well, some free some not. This will depend partly on the EHR vendor's approach to PHRs. Either way, you can expect to see a growing demand to communicate health information to your patients not just other providers.  

Alistair Jackson, M.Ed.

How reliable is your patient history?

You've probably noticed that discussions and announcements of patient portals and Personal Health Records (PHRs) are starting to dominate the health care media. Despite the buzz around Stage 2 Certification, EHRs are becoming yesterday's news and we're moving on to communications, both provider-to-provider and provider-to-patient. Which type is more important to establish for your business? Both are important, of course, and perhaps the two need not be juxtaposed. Nevertheless, herein lies an interesting discussion.


Your patient encounter has long begun with a patient history of some sort, right? For years, your patient has arrived early, sat in the waiting room filling out paper forms, then a staff member has entered data into your practice-management and/or EMR software. Next, your pretest technician sits with the patient and reviews the paperwork, asks a few more questions and records as a complete a personal, family and social history as possible. As the doctor, you probably attempt to improve on whatever you've been given, knowing the patient will tell you more because you're the doctor.


The essential question is, "How reliable is that patient history?" 100%? 80%? How about 20%? Last week, I was in an office supervising the Go-Live process for a new client. I sat with the technician through the pretest, observing documentation of the patient history. 


"Any medications you're on right now?" the technician asked. The patient gave the names of two medications.


Given the benefits of integrated e-prescribing, I had been able to take an advance peek and knew that the patient was actually taking nine (yes, 9) different medications and that all nine had been refilled in the past month! Before the doctor saw the patient in the exam lane, I mentioned, "I'm not going to tell you how many meds this patient is on but I can tell you it's a lot more than she told your technician. You might want to see if you can get a better history."


Try as he might, the doctor was not able to get the patient to move off the original report of two medications. Now, we could find all manner of reasoning to say that this is the exception rather than the rule. However, it's not the exception; it's the rule! Whether it's about medications or family history, a lapse of memory, genuine ignorance or downright deceit, we are consistently finding that patient histories, on average, are about 20-25% reliable.

That poses an interesting problem for the patient portal, does it not? How does patient information, entered into an online form, change the reliability factor? Can you expect it to be any more reliable at all? Let's suppose, though, that this approach yields an unlikely 100% improvement. Is that enough? Is it sufficient that you record a patient history you believe to be 50% accurate on average and pass that along to the next provider? Remember, if you are doing Meaningful Use, when you finish your exam, you are giving the patient a copy of their Continuity of Care Document (CCD).  Think how it reflects on your office reputation when that patient gives your CCD to the primary care physician and it's inaccurate. Supposing the information is only 25-50% accurate, does it reflect well on you as one of the patient's health care providers?

You have an alternative that's better than any patient-dependent history, whether given verbally or via web portal.  Just as you must be able to create and give the patient an electronic copy of the CCD after your exam, as a requirement of Meaningful Use, so must the patient's other physicians.  Ask the patient to request that the physician send you the CCD electronically and it is now technically possible for the CCD to automatically populate your exam forms with highly accurate information. Although portals are popular today, consuming the CCD from the primary care physician into your exam is the very best way not only to decrease the amount of effort to document an exam, but to get the improvement in quality of data needed for success in the new arena of health care delivery.

Patient portal or a CCD containing the problem list, meds list, allergies list and lab results from the PCP, which would you rather have? Yes, both of course. That's where we're going. Before we get there, certain conflict issues need to be resolved. For our part, we're betting first on the CCD.


Jim Grue, O.D.
Alistair Jackson, M.Ed.

Bundled payments ... ubiquitous change!

I'm a big believer that trends flow to their logical conclusion. If we look at the initiatives under way today in coordinated care, it should be no surprise that changes in the delivery model will flow to changes in the reimbursement model.


Look at this background statement for the Bundled Payments for Care Improvement initiative, from the CMS Innovation website:

Medicare currently makes separate payments to providers for the services they furnish to beneficiaries for a single illness or course of treatment, leading to fragmented care with minimal coordination across providers and health care settings. Payment is based on how much a provider does, not how well the provider does in treating the patient. 

Research has shown that bundled payments can align incentives for providers – hospitals, post acute care providers, doctors, and other practitioners– to partner closely across all specialties and settings that a patient may encounter to improve the patient’s experience of care during a hospital stay in an acute care hospital, and during post-discharge recovery.

As expected, most health care reform initiatives are contextualized in the hospital setting and flow from there into ambulatory care settings. It's important, therefore, that you, as an independent health care provider recognize Accountable Care Organizations (ACOs) as the bridge between these two worlds.

ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.  

While the statement above comes from CMS, recognize that today there are more commercial ACOs than Medicare ACOs. It is a dangerous gamble to segregate CMS initiatives from those of other payers and pretend the trends don't matter because you don't see many Medicare or Medicaid patients.

In a similar vein, we still encounter the equally harmful gamble that "this is all going to go away" in the supposed defeat of Obamacare. Not so. While some aspects of payment reform (health insurance reform) will survive and others won't, health care reform is here to stay. It is not the object of the pending Supreme Court decision. For the well being of your business and private-practice profession, look back then look ahead. Ubiquitous change. Are you preparing for what it means to you? Are you participating alongside your colleagues to ensure that independent eye care providers have a place in the emerging models of health care, both delivery and reimbursement?

Alistair Jackson, M.Ed.

Coordinated care leads to bundled payments

Coordinated care is by no means a new concept or recent buzzword but it does flag some important developments in the ongoing transformation of health care. In our discussions with eye care providers it is not yet apparent that many have grasped the significance of press releases like the one on June 6 from CMS entitled, “CMS Announces Private-Sector Commitments to Improve Primary Care for Patients, Save Money for Medicare: Eight States will test unique investment in coordinated care”. 

“In a strong show of support for more effective, more affordable, higher quality health care, 45 commercial, federal and State insurers in seven markets today pledged to work with the Centers for Medicare & Medicaid Services (CMS) to give more Americans access to quality health care at lower cost.”

The announcement goes on to explain a new initiative that impacts the business of every eye care provider from coast to coast, even though it specifies pilot projects in only eight states. Why is this important to you as an ECP? Because pilot projects like these signal ubiquitous change. If we understand the big picture, we can see that coordinated care spells the eventual demise of fee-for-service care billed directly by you to CMS or any other payer. To the extent that you don’t bill much to CMS, look past Medicare and Medicaid. See the private-sector commitments and public-private partnerships. Ubiquitous change.

“Under the Comprehensive Primary Care initiative, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services. Simultaneously, participating commercial, State, and other federal insurance plans are also offering an enhanced payment to primary care practices that provide high-quality primary care. 

"We know that when we support primary care, we get healthier patients and lower costs," said Acting CMS Administrator Marilyn Tavenner, "This initiative shows that the public and private sectors can come together to meet the critical need for these services."

Insurers in Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley Region, Ohio’s and Kentucky’s Cincinnati-Dayton Region, and greater Tulsa, Oklahoma signed agreements with CMS to participate in this initiative. The markets were selected based on a diverse pool of applicants from commercial health plans, State Medicaid agencies, and self-insured businesses who hoped to work alongside Medicare to support comprehensive primary care. 

In order to receive the new care management fee from CMS and insurers, primary care practices must agree to provide enhanced services for their patients, including offering longer and more flexible hours, using electronic health records; delivering preventive care; coordinating care with patients’ other health care providers; engaging patients and caregivers in managing their own care, and providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs. 

Approximately 75 primary care practices will be selected to participate in the Comprehensive Primary Care initiative in each designated market ...

The Comprehensive Primary Care initiative is a four-year initiative administered by the Innovation Center. Applications will be accepted until July 20.

For more information, please go to: http://www.innovations.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative/index.html”

Takeaways for you as an independent eye care provider:

1. Getting connected with primary care is imperative to the survival of your business.
2. Coordinated care management fees mean that qualified entities will take over the complete care of the patient, including assigning their eye care provider.
3. Enhanced services include using EHRs, delivering preventive care (that’s you!) and coordinating care with patients’ other health care providers (that’s team-based care).
4. Chronic care is defined as two back-to-back billings by a provider for the same condition or diagnosis (that’s everyone, all your patients in due course).
5. Coordinating care with other health care providers means electronic communications … exchanging CCDs and other forms of patient information.
6. The National Eye Care Communications Project is focused precisely on helping you meet these requirements. 
7. The CMS Innovation website is a tremendous resource for understanding where the transformation of healthcare is taking us. We strongly recommend that you go there and read up on ACOs, Bundled Payments and the Comprehensive Primary Care Initiative. Links to all three topics are available in the bottom section of the home page.
8. Join us next day for more on the logical conclusion of coordinated care ... bundled payments.

Alistair Jackson, M.Ed.

Jim Grue, O.D.

A use case for eye care

We mentioned last day that EMRlogic had presented at the ONC's Direct Demonstration Showcase in Washington, DC. Why was our use case selected? First, because it met the requirements of a closed-loop referral involving the primary care physician (PCP), a specialist provider (ECP) and a patient (PHR). Second, our use case was unique and interesting. We designed it to demonstrate the value independent eye care providers can bring to team-based healthcare. Here are the essential points of the use case:

• 28 yr old patient presents at rural optometry practice (ECP) for routine exam. Patient reports blurred vision. Problem list from CCD indicates gestational diabetes. 
• Patient reports one year since routine post-partum visit. ECP alerted via software's Clinical Decision Support (CDS) that best practice standard not met. Patient referred back to PCP for follow-up. 
• PCP orders routine lab tests. 
• PCP office receives lab results via Direct into EHR inbox. Office manager reviews and assigns to PCP and attaches lab results to the patient medical record. 
• PCP forwards lab results to patient’s PHR using Direct. 
• PCP notifies patient via Direct message to contact office for follow-up visit.

This use case is just one example of why independent eye care providers, many of them beyond the geographical reach of large health systems, are so important to the healthcare system we want and need. 


Notice that the patient did not go to the doctor because she felt she was sick. She went, in fact, feeling healthy. The signs and symptoms of her gestational diabetes were gone. Breast-feeding over, hormones back to normal, she went to her eye doctor simply to have her prescription renewed. It is the eye doctor seeing the "healthy" patient who has a unique opportunity to return the patient to her family physician for needed follow-up and preventive care.


In the same way that the software's CDS can alert the eye care provider to the need for follow-up care, it can equally well advise him or her of the ocular side effects of prescribed medications. (See a clear example on our web site's home page.) In team-based healthcare, other physicians will look to ECPs to provide this insight. None of us can know this for every drug ... but software can. That's one thing computers do exceedingly well. 


Back to the basics: 

• EHRs are more helpful than paper charts. 
• The use of EHRs is not an end in itself.
• You must move beyond EHRs to the exchange of health information.
• Sharing and communications are cornerstones of team-based coordinated care.
• Team-based delivery implies team-based reimbursement.
• You cannot get paid if you cannot or do not participate in care teams.
• You must prove both ability and value before you will be accepted onto care teams.

Alistair Jackson, M.Ed.
Jim Grue, O.D.

"DIRECT saves time."

Last week, EMRlogic participated in the 2012 Direct Implementation and Adoption Summit in Washington, DC, a meeting of the ONC State HIE Program. We played our part in the Direct Demonstration Showcase. The showcase featured 15 use cases, each one selected to demonstrate how the Direct protocol is being used to improve the secure exchange of protected health information at a national level. (You can see more about our role here.)


The last day of the meeting began with an open mic, inviting comments from attendees. The first comment came from a Rhode Island executive, a short but profound statement: "Direct saves time."


Our use case was a great example of that, not due to the case details but because our technology has achieved what the ONC Director, Dr. Farzad Mostashari said would be realized system wide in Stage 2. As we continue down Reform Road, moving from electronic health records (the collection of PHI) to electronic communications (the exchange of PHI), we indeed have the opportunity to save time ... and effort as well.


Picture this sequence of events: 

• you receive a Continuity of Care Document from a primary care physician for a patient you have never seen in your office 
• your software consumes the CCD and, in so doing, automatically creates and populates a new patient file, complete with patient demographics
• your software also creates an exam record, complete with the new patient's problem list, medication list, allergy list and lab results.

Remember how you worried that EHRs would slow you down? Indeed they can. And remember when you thought your software required too many clicks? That may be true as well. But here's an example of how the intended exchange of CCDs can save you hundreds of clicks and 15 minutes per patient. The time saved is not just provider time but also staff time and patient time.

Any way you slice it, that's a significant benefit to your business. Think of it not only as saving time but also leveraging effort. As you engage in communications and understand where connected care can take your practice, recognize that every time another office enters patient information into their software, you have the opportunity to leverage their time and effort.

Direct saves time ... and effort.

Alistair Jackson, M.Ed.

Communications, Connected Care and Medical Homes, Part 2

Continued from last day, "Communications, Connected Care and Medical Homes, Part 1"...


Why are Medical Homes relevant to the National Eye Care Communications Project? 

Joining the dots back through our recent posts in the Communications series, let’s understand the significance of the PCMH in its big-picture context. 

• Your patients are becoming accustomed to the new patient-centered medical home, through their family physicians. 
• As expectations change, patients will transfer them to all health care providers.
• Since the patient-centered medical home resides effectively in Accountable Care Organizations, you must participate in team-based care.
• Team-based care requires secure electronic communications, both to providers and patients.
• Your state HIE is the home base of your communications network.
• ONC Direct is the secure transmission standard required in every state and for national communications.  
• Beacon Communities are case studies where we can see clearly what the transformation of healthcare to a connected-care model, with the full range of certified EHR technology, is supposed to look like.

Alistair Jackson, M.Ed.

Jim Grue, O.D.

Communications, Connected Care and Medical Homes, Part 1

What are Medical Homes? 
In the previous post, we saw that ACOs are rapidly becoming the new status quo in healthcare delivery and reimbursement. Healthcare is becoming team-based and reimbursement likewise. Patient-Centered Medical Homes (PCMHs) are taking flight within ACOs. 


From the American Academy of Family Physicians (AAFP), here are four building blocks your local PCPs are using to build the practice as a Medical Home.   Note the significance of the patient experience. 


Building Your PCMH?


A truly patient-centered medical home is designed to enhance the patient experience – a fundamental, transformational shift from the practice designed to enhance physician workflow.


In a medical home, the practice is organized around the patient. Communication is based on trust, respect and shared decision-making. Patients want access to personalized, coordinated and comprehensive primary care when they need it, when it’s convenient for them. They also want convenient access to practice information.
• Provide convenient care. 
• Develop your practice's online presence. 
• Assess patient satisfaction. 


A patient-centered medical home automates business and clinical processes, depends on clinical decision support tools, and connects patients with the health care team.
• Connect and communicate: e-Prescribing, email and secure electronic messaging.
• Clinical data: capture and analyze. Medication histories, for starters. 

Two fundamentals for a patient-centered medical home: an engaged and productive staff and an organized and disciplined approach to finances.
• Build a productive and supporting environment 
• Put finances in order 
• Install a system to collect data.  
• Use the system to improve care. 


To be continued. Join us next to see why Medical Homes are relevant to the National Eye Care Communications Project.


Alistair Jackson, M.Ed.
Jim Grue, O.D.

Communications, Connected Care and ACOs, Part 2

Continued from last day, "Communications, Connected Care and ACOs, Part 1" ...


Why are ACOs relevant to Eye Care and the National Eye Care Communications project? 

Changing your practice to demonstrate the ability to be a productive team member is significant and helping you do this is one of the primary goals of the NECC Project.

In a nutshell, ACOs matter. They appear to be all about larger health systems, hospitals and group practices but as the health care reform game plays out ACOs are taking control of access to your patients, in the name of “shared savings”. Your patients still need eye care and if you're not involved in your local ACO, your patients will be awarded to others who are. Hospital-based EHRs don't do as good a job of eye care as your EHRs do, but they are nevertheless certified and meet Meaningful Use criteria. That means you can lose patients to those providers and systems. You owe it to yourself at least to be finding out if you have an ACO in your locality, or if any of the health systems in your area are working toward forming one. Since many ACO's are still at the formative stage, now is the perfect time for you to get involved. Once they're functioning, it may be too late to open the door for your participation.

ACO's are a good example of how health care reform doesn't apply only to providers who take Medicare. As seen in the link above to the list of 80 current ACOs, team-based care and reimbursement has already well surpassed the bounds of CMS. You may not be driven by the CMS EHRs Incentive Program and, certainly, your involvement in the National Eye Care Communications Project doesn’t require meaningful use attestation. But if, by virtue of the fact that you cannot communicate as required with other health care providers, you do not qualify to participate on a chronic care team, then your business consequences will far surpass any CMS penalties.

If you're not already aware of the ACOs being organized in your area, not already talking to "the powers that be", you may have an uphill battle to be included. We encourage all NECC Project participants to get on this now. It's critical that eye care providers be involved in chronic care teams. The question is not whether ACOs want to include eye care; it’s whether the ECP will be a hospital-based employee or potentially an independent eye care provider.


Alistair Jackson, M.Ed.
Jim Grue, O.D.