Healthcare Grants and Funding

National Rural Accountable Care Consortium Approved for $3.2 Million Beyond Original Budget

The National Rural Accountable Care Consortium was approved for $3.2 million in federal funds beyond its original 2018 budget to expand its work preparing clinical practices nationwide for new reimbursement models.

The so-called carryover award from the Centers for Medicare and Medicaid Inn ovation (CMMI) targets a more personalized level of service for clients. For example, the funds will allow the organization to offer more on-site visits with clients and enable the hiring of additional practice-improvement staff.  Other service enhancements include practice-level support for quality-data extraction and interpretation of quality results.

The National Rural Accountable Care Consortium’s (NRACC) practice-transformation program is grant-funded and therefore offered at no cost to enrolled clinical practices. The Transforming Clinical Practice Initiative (TCPi) that houses the program is responsible for offering clinical practices technical support for Medicare’s Quality Payment Program/ Merit-based Incentive Payment System (MIPS).  NRACC’s staff offers enrolled practices expert consulting on MIPs that is tailored toward the practice’s specific needs and goals.

NRACC is ‘open for business,’ and actively recruiting and enrolling eligible primary and specialty care clinical practices nationwide.  To be eligible for enrollment, clinical practices must not already be participating in an a Medicare Accountable Care Organization (ACO) or the Comprehensive Primary Care Plus (CPC+) program, and they must not already be enrolled in a a competing Transforming Clinical Practice Initiative Practice Transformation Network.

NRACC’s grant-funded services include being matched with a dedicated practice-improvement coach, one-on-one monthly coaching calls, training to set up a billable care coordination service, population health software, plus proven curriculum for redesigning clinical workflows to manage population health and ensure financial sustainability.

Contact NRACC’s director of network and strategy Maeve McClellan or (916) 542-4590, for more information about enrolling your clinical practice or click here to apply now.

Qualify for Comprehensive Primary Care Plus Program by September 15 Deadline

Comprehensive Primary Care Plus (CPC+) will pay well-deserving primary care providers an additional $100,000 to $250,000 per year, in addition to fee-for-service, for care that has previously been largely uncompensated.

Today, primary care physicians spend many hours outside the exam room, documenting patients’ history and following up on referrals, but do not get paid for activities that are not face to face. CPC+ allows doctors to spend more time during the day with patients and less time after hours on paperwork.

Track 1 and Track 2 participants are paid $180,000 to $320,000 per 1,000 patients per year for Care Management Fees, respectively, and are also eligible for $30,000 to $48,000 per year in incentive bonuses. In both tracks of the program, practices must have a care coordinator, promote wellness, use claims data, have 24/7 access, align patients with providers and report on quality.

In addition to the aforementioned $320,000, Track 2 primary care providers can get as much as 71.5% of the reimbursement previously confined to face-to-face visits, using patient-pleasing methods such as phone, email, or text advice. All procedures and routine office visits are still fully billable under the physician fee schedule, sometimes for higher rates. In either track, beginning in 2019, the practice will also receive a MACRA payment of 5% of Part B billing for five years and will be exempt from the Quality Payment Program (if the practice has fewer than 50 physicians). Participation regions and states will be selected by August 1st.

Applications are due September 15. This is a multi-payer program.

The 5,000 practices that can participate in the model may be determining the fate of primary care payments for decades to come. The Comprehensive Primary Care Initiative was the most generous program to date under CMMI, and well received by providers, but only broke even in cost savings. It’s sequel, Comprehensive Primary Care Plus promises to go even farther in both the incentives and the requirements of the program. If successful, the Secretary has the power to make the program permanent, and CPC+ pioneers can define a bright future for primary care payments.

To be eligible, practices must already have a care coordinator, promote wellness, have 24/7 access, align patients with providers and use data for care. Most small practices will not qualify without focused effort to implement the qualifying programs in a short period of time. To get assistance, please go to

National Rural Accountable Care Consortium Offers Free Participation in Medicare Shared Savings Program


Beaverton, Oregon – June 28, 2016 – Today the National Rural Accountable Care Consortium (NRACC) announced that Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), rural hospitals with less than 100 beds and independent practices may be eligible for free participation in the Medicare Shared Savings Program (MSSP).

NRACC anticipates many primary care providers will be moving into the new Comprehensive Primary Care Plus (CPC+) program this fall. This movement will allow other providers, not participating in the CPC+ program, to move into ACO Investment Model (AIM)-funded ACOs, where practices can receive all of the benefits of the Medicare Shared Savings Program at no cost.

Interested applicants must submit a non-binding application no later than July 15, 2016. If approved by the ACO Boards of Directors, successful applicants will be notified in October and have five business days to either confirm or withdraw their application.

“Accountable Care Organizations are a great way to get the data we need to help our patients,” says Dr. Mark Hamed, Medical Director of the Greater Michigan Rural ACO, an NRACC member. “The changes we have made in our practice workflows improve care for our patients and make it easier to practice medicine the way we have always wanted.”

McKenzie Health System CEO Steve Barnett agrees, “Patient-centered care under the ACO model has been great for our community and great for the bottom line of our rural health system. Patients leave the community for care less frequently, increase their preventive care compliance and stay healthier as a result.”

CPC+ is a new primary care payment initiative from the Centers for Medicare and Medicaid Services (CMS). According to NRACC Executive Director Monica Bourgeau, “CPC+ and the MSSP are two ways providers can participate in Advanced Payment Models. The MSSP greatly improves their results under MACRA. CPC+ is a Qualified Advanced Payment Model that exempts providers from MACRA and automatically earns a 5% Part B bonus. Either way providers and patients are better off.”

Monica Bourgeau, MS
Executive Director
National Rural Accountable Care Consortium
916.500.4777 (o)

Rural Providers Organized Under 23 Medicare ACOs Receive $46 Million AIM Funding From CMMI

I would like to share this news release which was released to the news media today.

Lynn Barr

Rural Providers Organized Under 23 Medicare ACOs Receive $46 Million AIM Funding From CMMI

Additional $31 million also provided by CMMI to prepare rural practices for value-based payments under new Practice Transformation Network

Nevada City, CA, January 12, 2016 — A pioneering group of rural physicians and hospital administrators came together in 2013 to begin the journey toward managing rural population health. Through innovation and collaboration, they sought to transform today’s rural healthcare delivery system into a world-class primary care system that provides professional satisfaction for clinicians, attracts consumers, and provides high-quality acute, post-acute and outpatient services that meet patients’ needs.

These rural thought-leaders joined forces to form the first National Rural ACO (NRACO) and create the NRACO Services Corporation (NSC), which has been supporting rural Medicare ACOs with training, data, analytics, patient satisfaction surveys, and evidence-based medicine programs since 2014. In 2015, NSC organized more than 6,000 providers in 159 rural health systems into 23 Medicare Shared Savings Program (MSSP) ACOs, and obtained $46 million in ACO Investment Model funding to support their ACO operations and local care coordination programs. This group includes 55 rural PPS hospitals, 92 Critical Access Hospitals, 168 Rural Health Clinics, and 39 rural FQHCs serving more than 500,000 Medicare patients.

Working with other key stakeholders like the National Rural Health Association and the National Rural Health Resource Center, the rural hospital CEOs also started the non-profit National Rural Accountable Care Consortium. The Consortium will assist hundreds of rural health systems in their journey toward accountable care, funded by a $31 million cooperative agreement award from the Center for Medicare and Medicaid Innovation (CMMI).

To date, the majority of National Rural ACO participants have demonstrated reductions in per capita spending while improving quality and patient satisfaction. Unexpectedly, this has also resulted in financially strengthening the majority of the participating rural health systems. Participating hospital CFOs are queried monthly on the financial status of their organizations, and none have reported negative effects of being associated with accountable care, while most have described increased revenue and improved staff satisfaction.

According to NRACO founding member Tim Putnam, CEO of Margaret Mary Health in Batesville, Indiana, “there will be significant opportunities to strengthen rural health systems by becoming an ACO or participating in a CMMI innovation model in the next 1-2 years, but providers must prepare.” Co-founder Melanie Van Winkle, CFO of Mammoth Hospital in Mammoth Lakes, California agrees, saying “this is the reason we exist, to take care of the community. The ACO helps us focus on our mission.” Steve Barnett, CEO of McKenzie Health in Sandusky, Michigan adds, “once you begin giving this type of care, you’ll never go back. We are very grateful for the support we have received from CMS, CMMI, MedPAC, and the Federal Office of Rural Health Policy. We wouldn’t be able to organize rural providers under this model without their help.”

Today, rural providers can get all of the support they need to be ready for value-based payments through the Consortium’s Practice Transformation Network, fully funded by CMMI. Medical office staff will be trained in population health management, including care coordination, quality improvement, annual wellness visits, and patient satisfaction, and can begin billing for these professional services.

Spaces are still available to join the Consortium’s Practice Transformation Network. In order to enroll in this federally-funded program that provides a population health infrastructure to rural practices at no cost, go to

Contact: Lynn Barr, Chief Transformation Officer



Summary of Key Rural Provisions in the 2016 Physician Fee Schedule

Following is a summary of the key rural provisions in the 2016 Physician Fee Schedule.

Advanced Care Planning:
CMS is approving new CPT codes 99497 (initial 30 minutes) and 99498  (subsequent 30 minutes) for explanation, discussion and completion of Advanced Directive forms for Medicare beneficiaries. The estimates of payment are $86 in an office setting and $80 in an inpatient setting. While this can now be part of the Annual Wellness Visit or a physician visit, and does qualify as an RHC visit, it cannot be billed in an RHC in addition to the All-Inclusive Rate.

Rural Health Clinics and HCPCS Codes:
RHCs will now be required to record all HCPCS codes for services provided during a visit, even though additional payment will not be forthcoming. It is essential that RHCs completely detail the services they provide. There is much debate about whether RHCs are not providing the same standard of care services as most fee-for-service clinics (such as smoking cessation counseling) or are they simply not documenting them because it does not affect payment. If you are doing the work, make sure you document it, or this could have negative consequences under payment reform. The new requirement for recording the HCPCS codes on the bill has been delayed from January 1st to April 1st 2016.

RHCs and FQHCs can Bill for Chronic Care Management (CCM) Codes:
Beginning in January 2016, RHCs and FQHCs can now bill $41.92 per patient per month under Part B for CCM services outside of the All-Inclusive Rate. Thanks, CMS! You heard our prayers.

New Quality Measure for the Medicare Shared Savings Program:
CMS is adding a new Statin Therapy for the Prevention and Treatment of Cardiovascular Disease in the Preventive Health domain.  The measure reports the percentage of beneficiaries whoe were prescribed or were already on statin medication dureing the measurement year and who fall into any of the following three categories: active diagnosis of clinical atherosclerotic cardiovascular disease, LDL-C > 190 mg/dl, or diabetics with LDL-C of 70-189 mg/dl. This new measure will be pay-for-reporting only for the next three years.

Changes in Assignment of Beneficiaries for the Medicare Shared Savings Program:
Primary care services that are delivered in a Skilled Nursing Facility (POS code 31) will no longer be considered for patient attribution.

To see all of the changes in the PFS, please go to

National Rural Accountable Care Consortium is Awarded TCPI Grant to Support Rural Health

On September 29th, Secretary Burwell announced that our non-profit organization, the National Rural Accountable Care Consortium, was awarded up to $31 million to support 525 rural health systems across the country to prepare for Advanced Payment Models.

Our program is designed to assist rural providers in redesigning their ambulatory practices to maximize their success under the new value-based payment models. We will provide them the tools to set up a Medicare-billable care coordination program. These tools include the necessary IT infrastructure and a 24-hour Nurse Advice hotline. We use data from electronic health records to help providers facilitate and optimize their ambulatory quality scores. They can also use this data to redesign their practice workflow to improve care and lower costs. The Consortium also sets up ambulatory patient satisfaction surveys, engages with  physicians and leadership, and provides guidance on how to participate in and increase revenue through Advanced Payment Models.

We are very grateful for the support that CMS and CMMI is giving rural providers. Working together, we can provide better care for our community, reduce unnecessary costs, and improve the financial performance of our rural health systems. For more information about this program, please see the CMS website.

Click here to apply for the program. 

The project described was supported by Funding Opportunity Number CMS-1L1-15-003 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services.  Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HHS or its agencies.

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 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 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?


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.