Author Archive: Lynn Barr

Top Twelve Reasons Independent Providers Should Join Their Community’s ACO

Payment is changing. Becoming a member of the National Rural ACO will help you prepare for the new payment models that will take effect in 2019. These new payment models will be determined using quality scores and the relative costs of your patients. National Rural ACO will work with your office staff to achieve success under these new models in the following ways:

  • Reaching quality scores in the 80th to 90th percentile (rural baseline is ~60%).
  • Promoting annual wellness visits.
  • Completely and accurately coding all current chronic diseases at each visit.
  • Pooling data to understand why your patients are more expensive than regional and national averages (e.g., certain diseases, post-acute care, drugs, DME, etc.) and deploying strategies to constrain those costs.
  • Coordinating care for your chronically ill patients.
  • Qualifying for Patient-Centered Medical Home Certification.
  • Providing 24-hour access to medical advice for your Medicare patients.
  • Getting complete claims data from all sources on your Medicare patients so that you can better understand the full spectrum of health care services they use, yet frequently do not report to their physician.
  • Getting drug refill information on your patients.
  • Obtaining important waivers of Start, Anti-Kickback Statute, Patient Inducement and Anti-Trust.
  • Gaining access to similar shared savings programs with other payers.
  • Preparing to be as ready as possible for future value-based payments.

Please contact us with your questions.

 

Rural Hospitals Face May 1 Deadline for ACO Signup

Time is running out for rural hospitals and healthcare systems to sign up to join the National Rural ACO and to qualify for special, one-time only, federal grant funds that can cover the full cost of membership for new applicants in 2016. The Center for Medicare and Medicaid Services (CMS) has committed $114 million dollars in grant funds to help rural health providers make the transition to an accountable care organization in 2016.

Now is the time to act.  Apply today to become an ACO.

Hundreds of rural health systems have expressed interest in joining the National Rural ACO this year. This is a unique opportunity to join a proven and successful rural ACO model that will position community health systems for the future; teaching them how to get paid more under the new value-based reimbursement models, while improving care for their community.

Watch this video to gain insight and important information about becoming an ACO and the path to a sustainable future for rural healthcare organizations.

The deadline for consideration is May 1, 2015. The fastest, easiest way to complete the required application letter on time is to go to the www.nationalruralaco.com website and click on the Apply Now button.  The application is non-binding, but for those who miss the approaching May 1st deadline there may be no other opportunity to qualify for the one-time grant funds from CMS.

Many rural providers believe they cannot participate in Accountable Care Organization programs because of cost, the limited numbers of beneficiaries or because they will be forced to take downside risk. National Rural ACO has developed a program that allows rural RHCs, FQHCs and hospitals to join regardless of size and with no downside risk. The program is a bonus program only and does not affect fee-for-service payments or cost-based reimbursement in any way.

At the National Rural ACO, we are working with rural healthcare providers across the country who are ready to join the movement to Accountable Care Organizations (ACOs) that improve the sustainability of healthcare systems through better health outcomes, better patient experience and lower costs, which result in higher payments.  Join us today. 

Call Your Congressman TODAY About the SGR Fix — What About Rural Health Clinics and FQHCs?

The “Doc Fix” is in play once more and looking to move toward approval. The attached document outlines how Congress intends to alter physician fee schedule payments, making 25% of physician payments variable based on cost and quality by 2020.

One of the key components of this legislation provides special incentives for clinicians who participate in Advanced Payment Models. “Professionals who receive a significant share of their revenues through an APM(s) that involves risk of financial losses and a quality measurement component will receive a five percent bonus each year from 2019-2024. A patient-centered medical home APM will be exempted from the downside financial risk requirement if proven to work in the Medicare population.”

Guess what? Providers that practice in RHCs and FQHCs (who are not paid under the Physician Fee Schedule) are not eligible for those five percent bonuses. This is a SUBSTANTIAL INCENTIVE that will leave rural providers behind in their costly efforts to transform their practices.

Call your congressman today and ask that the SGR Fix includes language that requires CMS to provide similar incentives for Rural Health Clinic and FQHC providers to join Advanced Payment Models.

CMS Wants to Hear From You!

CMS has released a Request for Information on transforming clinical practices. It is important for you to review this document and submit your comments to CMS no later than March 16, 2015. You can find the form to fill out here.

We must engage with CMS on these new payment models to define a unique approach for rural health systems. The National Rural ACO, a 501(c)3 organization governed by our founding members, supports a population health model where the rural health system is accountable for the care for its community. It preserves cost-based reimbursement, but allows us to earn more by coordinating care for our patients. The key elements of this model are that the community who lives in the primary service area of the hospital is assigned to the health system, who will proactively support them whether they get care locally or out of town. Critical to this model is the provision of Medicare claims data to the rural health system so we can identify patients who need our help, and also be able to evaluate the cost and quality of our referral network.

What are your ideas for payment reform? Let CMS know! And let us know, too. Rural providers need to lead the discussion. Submit your comments today!

CMS Wants to Hear From You!

CMS has released a Request for Information on transforming clinical practices. It is important for you to review this document and submit your comments to CMS no later than March 16, 2015. You can find the form to fill out here.

We must engage with CMS on these new payment models to define a unique approach for rural health systems. The National Rural ACO, a 501(c)3 organization governed by our founding members, supports a population health model where the rural health system is accountable for the care for its community. It preserves cost-based reimbursement, but allows us to earn more by coordinating care for our patients. The key elements of this model are that the community who lives in the primary service area of the hospital is assigned to the health system, who will proactively support them whether they get care locally or out of town. Critical to this model is the provision of Medicare claims data to the rural health system so we can identify patients who need our help, and also be able to evaluate the cost and quality of our referral network.

What are your ideas for payment reform? Let CMS know! And let us know, too. Rural providers need to lead the discussion. Submit your comments today!

CMS Pledges More Than $300 Million to Support Rural Health Transformation

The first Rural ACO Summit in Washington DC last week was a huge success. We engaged in terrific discussions with policy makers, made new friends among rural providers looking to enter the program, and connected rural ACO pioneers across the country. The presentations are available to download here.

Now, there is much work to be done and very little time to get the grant funding available to rural providers. Applications are due to CMS no later than July, and it takes at least two months to complete the application process.

HHS Secretary Burwell’s historic announcement telegraphs the future:

“Our first goal is for 30% of all Medicare provider payments to be in alternative payment models that are tied to how well providers care for their patients, instead of how much care they provide – and to do it by 2016. Our goal would then be to get to 50% by 2018. Our second goal is for virtually all Medicare fee-for-service payments to be tied to quality and value; at least 85% in 2016 and 90% in 2018.”

Most rural providers are exempt from these special payments, so it’s business as usual, right?

Wrong.

If you could see what ACOs see because they have the data….

Rural providers will typically have the highest UNIT costs and will have lower quality scores because they do not participate in PQRS or other quality programs and don’t know where to focus their efforts. You can’t improve what you can’t measure.

The reality is that our cost per beneficiary is lower, but nobody can see that data except for rural ACOs. Rural providers can’t tell this story without the data to prove it. Under the proposed new payment models, within a few years, a typical urban cardiologist could risk losing $100,000 – $300,000 per year in income if his patients are high-cost or if their quality scores are low, and much of this is out of his direct control – it depends a lot on where patients get primary care. It will be in his financial interest to only work with high-quality, low-cost providers, but most rural providers will appear to be low-quality and high-cost due to our lack of participation in ambulatory quality reporting and the way cost data will be presented to them.

Rural providers need to find ways to excel in ambulatory quality and to tell our story of lower costs per beneficiary. We need to help our patients prevent illness and/or navigate their disease. This is the essence of population health management, an essential skill and service of the 21st-century healthcare system. Becoming an ACO will get you where you need to go.

CMS wants rural providers to get into the population health game this year. To do so, they are funding up to 75 rural ACOs who apply in 2015 with $114 million. They are also providing $228 million in technical assistance, under the Practice Transformation Network, to those not yet ready to become an ACO. You must sign up this year to get subsidized assistance. Practice Transformation Networks will be announced this summer. ACO applications must be submitted by July, 2015. National Rural ACO can help.

Get started today, or sign up for our webinar on February 25th at 2:00 PM EST.

Your Seat at the Table

The speed of change in healthcare is breathtaking, and the latest announcements of ambitious new goals and timelines will turn the pressure up even more.   To quote Secretary Burwell, “our goal is for virtually all Medicare fee-for-service payments to be tied to quality and value; at least 85% in 2016 and 90% in 2018.”

We see some real world challenges for rural health. Twenty percent of Medicare fee-for-service beneficiaries live in rural America, yet rural health clinics and FQHCs are exempt from value-based payments and quality reporting; including PQRS, Value-Based Modifiers and Medicare Meaningful Use. Instead of celebrating our freedom from regulations, we should be very worried about how these changes could devastate the rural safety net and negatively impact our patients.

If the rest of the delivery system is paid on quality, and we aren’t, we become a liability to our referral network. CMS is making everyone else report on quality because they know that when we report quality, we improve. CMS is creating a quality chasm. If we don’t participate, our resulting lower quality will negatively affect our patients and our partner’s payments.

If the rest of the delivery system is paid on cost, and our unit costs are higher because of special payments, we become a liability to our referral network. Our special payments will negatively affect our partner’s income.

Given 1) and 2) above, the pressure for our partners to optimize value will result in our patients being diverted from our health systems. Declining quality and volumes will increase costs further, creating a death spiral for rural health systems. Yet today, even if we wanted to participate in quality reporting programs, we don’t have the same access to information or option to do so other than through the Medicare Shared Savings Program (MSSP). And although Medicare has the ability to “standardize” our payments to the PPS rates (like they do with IME, DSH, GPCI and others to protect urban safety net providers), they do not make those concessions for rural payments, putting the target squarely on our backs.

This announcement could not have come at a better time!

The National Rural Accountable Care Organization and our thirty member hospitals and community health systems are now in our second year, working together with a clear unified voice that is being heard and changing policy that will secure the future of rural health care in America. We are most proud of our members who are creating patient-centered health systems, leading rural healthcare policy reform discussions and taking charge of their destiny.

To us, the new goals and timelines proposed by HHS Secretary Burwell are simply the next initiative coming from the rapid-changing machinery behind the ACA. There’s much to fix and much to do. We’re ready. We will be in Washington DC the week of February 2nd at the Rural ACO Summit to kick off our 2015 campaign for transforming accountable care for rural communities. We can use your help.

  1. by February 6th. Download our CMS comment letter here.
  2. Activate your political network.  The plight of rural healthcare needs to become a state and national issue.  Too much is at risk for communities that do not act. Ask you representatives to demand that CMS standardizes all rural payments to the PPS rate for the purposes of value-based payments. Download a sample letter for your congressman here.
  3. Join us.  The National Rural ACO. Your seat at the table.  Your path to a sustainable future.

Secretary Burwell Throws Down the Gauntlet

On January 26th, Secretary Burwell laid out an ambitious goal of having “30% of all Medicare provider payments to be in alternative payment models that are tied to how well providers care for their patients, instead of how much care they provide – and to do it by 2016.Our goal would then be to get to 50% by 2018.”

See her blog post on the topic here.

She continues, “Our second goal is for virtually all Medicare fee-for-service payments to be tied to quality and value; at least 85% in 2016 and 90% in 2018.” Hmmm. More than 20% of fee-for-service payments are for rural beneficiaries, yet RHCs, CAH’s and FQHC’s are the only providers whose payments are not tied to quality and value. No PQRS, no value-based purchasing, no value-based modifiers, not even Medicare Meaningful Use. How will the Secretary achieve her goal without offering incentives for rural providers? As one CEO wrote to me yesterday, the times they are a’changin.

Expect more to come from HHS. We’d like to help the Secretary achieve her goal with better incentives for rural providers to participate in ACOs. Better payments, better assignment, more flexibility and having Medicare pay residual cost-sharing for our seniors to encourage them to get care in their rural ACO would go a long way.

Please review our comments letter here.  If you agree, go to www.regulations.gov and send in a comment on CMS-1461-P supporting our ideas. Comments matter! And so do rural beneficiaries!

Secretary Burwell Throws Down the Gauntlet

On January 26th, Secretary Burwell laid out an ambitious goal of having “30% of all Medicare provider payments to be in alternative payment models that are tied to how well providers care for their patients, instead of how much care they provide – and to do it by 2016.Our goal would then be to get to 50% by 2018.”

See her blog post on the topic here.

She continues, “Our second goal is for virtually all Medicare fee-for-service payments to be tied to quality and value; at least 85% in 2016 and 90% in 2018.” Hmmm. More than 20% of fee-for-service payments are for rural beneficiaries, yet RHCs, CAH’s and FQHC’s are the only providers whose payments are not tied to quality and value. No PQRS, no value-based purchasing, no value-based modifiers, not even Medicare Meaningful Use. How will the Secretary achieve her goal without offering incentives for rural providers? As one CEO wrote to me yesterday, the times they are a’changin.

Expect more to come from HHS. We’d like to help the Secretary achieve her goal with better incentives for rural providers to participate in ACOs. Better payments, better assignment, more flexibility and having Medicare pay residual cost-sharing for our seniors to encourage them to get care in their rural ACO would go a long way.

Please review our comments letter here.  If you agree, go to www.regulations.gov and send in a comment on CMS-1461-P supporting our ideas. Comments matter! And so do rural beneficiaries!