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.