Accountable Care Organization (ACO) authorization (2013, allergies, cost of)

[bluecomet]

Relative received a letter from WakeMed Community Care requesting approval to participate in ACO where groups of physicians/providers share Medicare information. Not sure this is a good idea as other personal information may be compromised. Any recommendations from legal or medical posters?

[J_Lurk]

If they compromise your information it is still a HIPAA violation. They can only share information with others in the ACO.

Accountable Care Organizations (ACO) - Centers for Medicare & Medicaid Services

Personally I'd do it because of the opportunity for better coordination of care.

[CHTransplant]

Originally Posted by J_Lurk

If they compromise your information it is still a HIPAA violation.

For which there is no private cause of action by the way. But you can file a complaint form with the federal government.

[WeLuvNC]

I would totally want to be in an ACO -- it means increased coordination of care for you personally.

So...instead of every doctor drawing a CBC (blood work via a lab), they will be more likely to share this information with each other, decrease duplication of services, and provide better care for you. At least that is what the current research literature is demonstrating which is why there are more ACOs coming about. Whether this stands the test of time with it being rolled out across the nation will be interesting.

Yes, they are supposed to coordinate care now but sometimes it is easier to spin a Hct to check for anemia or run an HbA1c (for diabetes monitoring) so decision making can be done on the spot rather than track down your last labwork and have to follow up with you with a plan of care. And that is making the assumption that you even remembered/knew you had bloodwork done recently. Often, this information is lost or the patient is not even asked so the test is just re-done. Multiply this by a many patients and you will see why this gets to be expensive. If you can eliminate the cost of provider time and/or the cost of re-doing the test then HC saves money...

If you are concerned about personal information being shared amongst health care providers then you can keep an eye on that by requesting who is accessing your information per HIPAA.

However, if this is a concern for you, then you might be interested to hear that the NC HIE might be more of a concern.

The current policy for the NC HIE is 'opt in' and you have to say 'opt out' rather than the other way around. On the surface, it sounds great - sharing of "Your NC HIE record contains prescriptions, vaccinations, allergies, lab and test results, image reports, conditions, diagnoses or health problems and medical visit notes. " SO, the idea is that information can be accessed statewide as needed for your healthcare regardless of where you are and who the ED or provider is networked with.

http://nchie.org/wp-content/uploads/...or-website.pdf

My concern with the HIE is you have to get any errors fixed via the healthcare organization that put it in and patients cannot directly add to or correct any information in the HIE.

This strikes me as bad in this day and age where patients are having to manage so much of their care coordination.

Why does it make me nervous? Let me ask you this - how many times have you gone into an office and the medication list has actually been accurate??

Also, I have personal experience that once an error is in an electronic record, it is very difficult to get rid of it, once and for all.

For example: an incorrect allergy entry keeps popping back into my son's medical record - I ask that it be fixed each time I hear it has popped back into 'current allergies'. I am assured it will be fixed but it randomly pops back in - no idea why. Each time they transition to an upgrade or a new system is my suspicion. I have taken to carrying the labwork results as proof to every visit in case it pops back in, so it gets corrected on the spot rather than doing a phone dance.

I have also seen this with diagnoses and prescriptions -- something is entered that isn't quite right and it is corrected. now all of that will be shared across providers and as a consumer we cannot go in and indicate that "I couldn't tolerate abc medication so the doctor changed it to xyz instead". Instead, it may look like you took both, and you will forever have to remember and explain 'please don't prescribe abc medication b/c it made me vomit'.

I think the NC HIE would be great if they allowed patients to access, update, and add information entries to it as well. But the way it stands now, the information contained may have accuracy issues. and if you cannot trust the information there, then how can you rely on it for healthcare decision making?

In any event, if you want to Opt-Out because of privacy or accuracy concerns, then go here:

http://nchie.org/wp-content/uploads/...rm_English.pdf

To learn more about the NC HIE, then go here:
Patients

[bluecomet]

WakeMed Key Community Care is one Accountable Care Organization. Not all of my physicians participate in Wake Community Care ACO. Do ACO's share data with other ACO's?