National Rural ACO

News, commentary and opinion on the ongoing transformation of our health care systems.

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Does CMS Really Hate Rural Hospitals?

We often hear in our travels the opinion that CMS wants to close rural hospitals and have everyone use urban hospitals instead. Many think that CMS believes rural hospitals are too expensive and provide low quality care. They point to the plethora of innovation models focused on urban areas, with almost no rural health system participation, unless the rural member joins as part of an urban system. Sixty percent of rural health systems are supported by local tax dollars and would rather “live free or die.”

Is it that CMS doesn’t care, or is it that they don’t know? Historically, health insurance payment innovation has always come from the private sector first. Commercial insurers created ACOs long before Medicare did. Diagnosis Related Groups (DRGs) were a commercial insurance innovation. Capitation and HMOs were tested in the private sector first. The government needs data and experience before it can implement new payment models, and the private sector is not testing new models in rural America. Furthermore, urban payment models cannot scale down to rural health systems. Everyone remembers when DRGs were implemented in rural hospitals. Hundreds of rural hospitals closed as a result. CMS is wise to be cautious.

As rural healthcare providers, we are going to have to lead innovation if we want to survive. No one else can or will do it for us. We have formed the National Rural Accountable Care Organization so that we can pool our resources, our knowledge, our lives and our ideas to create and test new payment models. The future of our communities depends on us working together. Join us.

Celebrate National Rural Health Day on November 20

This was written by my colleague Bob Humphrey of CSPI and I want to share it with you.  Celebrate Rural Health Day!

National Rural Health Day

November 20th is National Rural Health day. As a former CEO of 3 rural hospitals in Alabama, let me share my thoughts on the important role of our rural healthcare providers, employees and volunteers and their contribution to the fabric of rural America.

In the small, rural hospital we know our patients; we know their first name and their relatives. We know the patient whose grandfather started the town’s feed store. We respect the intent of HIPAA, but we respect our patients even more.

We provide good quality care. We have excellent clinical systems and our quality and patient satisfaction scores rival any medical center. Our employees are knowledgeable and work hard; and many have worked at our facility for decades.

We have been under constant financial pressures lately, mainly due to scale, but we will persevere because the alternative is not acceptable to us or our community.

There have actually been some developments that should offer some encouragement to us and relieve some of this financial pressure….

-adoption and acceptance of telemedicine along with fair reimbursement

-our existing and longstanding rural primary care base will be a strength as we shift the payment model to ACOs and other Value Based Purchasing mechanisms

-our economic value to the local community is being fully realized

-our high quality measurement scores and patient satisfaction scores are being recognized by our community, peers and by payers and leaders on the national level.

All of this give us reason to celebrate Rural Health Day and here are some ways to celebrate…

-Go see the doctor who has been there for 30 years and shake his /her hand.

-Have a cup of coffee with the coworker who has been working at the hospital since they wer 18 years old.

-Take hold of a patient’s hand that you know has been in your hospital several times and assure them that we will always be there to take care of them.

-Thank a volunteer for their special role at the hospital.

-Tell Dietary how good that Peanut Butter pie is and Housekeeping how spotless the patient rooms are.

-Visit the employees out back in the trailer and thank them for their contribution to the mission of the hospital.

Then try to leave work early enough to catch the sunset over your community and reflect how vital your hospital is to you and all of those around you.

Go Rural!

Rural ACO Summit Set for February 2, 2015 in Washington, DC

Fifty-nine Critical Access Hospitals joined ACOs in order to participate in the Medicare Shared Savings Program in 2014. This number will more than double in 2015, representing more than 10% of all CAHs. CMS is providing $114 million in grant funds for up to 300 rural health systems to join the program in 2016. The National Rural ACO is hosting a free educational conference at the Capitol Hilton in Washington, DC on Monday, February 2nd, 2015; the day before the National Rural Health Association’s Policy Institute. Visit www.ruralaco.com to learn more about the conference.

The Rural ACO Summit, sponsored by the National Rural Health Association and the National Rural Accountable Care Organization, will bring together experienced 2012-2014 rural ACOs, new 2015 rural ACO participants and potential applicants for the 2016 Program. Participants will learn the basics of ACO participation — including positive and negative effects on budgets, staffing, billing, and utilization. They will learn about policy issues that must be addressed to fix unique rural issues and the benefits of the ACO program, including important waivers and full access to claims data for your patients.

Who Should Attend?

New or existing ACO participants will not want to miss this opportunity to hear the latest from CMS and the experts in Washington while meeting with other ACO members from across the country looking to share information.

Prospective ACO applicants should attend to gain valuable first-hand knowledge from early adopters and recognized experts in the program. It will be a fantastic opportunity to determine whether you can, or should, join an ACO.

Attendees will also learn how to qualify and apply for the exciting new ACO Investment Model Program, $114 million dollars already allocated by CMS which pre-pays qualifying applicants, providing the start-up capital to fund rural ACO participation.

CMS is at the table. Are you? We look forward to seeing you in Washington, DC!  Click here to register today. There is no cost to register.

Click here for more information about the Policy Institute.  We look forward to seeing you in Washington, DC on February 2, 2015.

Kicking Off the 2015 ACO’s

We’ve enjoyed a strong start launching Rural ACO steering committees last week. The member driven committees bring physicians, hospital administrators, community care coordinators as well as senior leadership from clinics, marketing, compliance, case management and emergency departments together to implement the programs that will drive improved patient care and lower costs.

In our daylong launch gatherings, it was interesting to hear comments from the gathered professionals. There was a genuine excitement. I overheard several conversations about “doing the right thing”, “getting the resources needed to improve patient care”, “coordinating with community resources”, “not letting patients slip through the cracks.” In one conversation I caught how “It’s been a long time coming. We went through managed care in the 90’s and abandoned it. This is different. We are breaking a vicious cycle, finally with the right alignment of incentives. This is why I went into healthcare in the first place.”

What were our steering committee members most concerned about? Patient access was top of mind and the ability to schedule enough appointments for the increased demand for services coming from chronic patients now managed by the new community care coordinators. A CFO expressed some questions about how a new program will affect the finances of his organization. We put him in charge of the program. The change from fee-for-service to a fee-for-value model is a transition. We can go as slow or as fast as the team decides to run, so we start every meeting with getting feedback from the CFO on whether the pace of change is too fast, too slow or just right and adjust the program accordingly.

We are off and running, and so are our member healthcare communities who have enthusiastically joined our effort to help rural communities collaborate in order to be able to afford and qualify for innovative payment models that support better care, lower costs and the sustainability of rural health systems.

2015 Physician Fee Schedule Released – Join Us on Nov. 11 to Discuss

On Friday October 31, CMS released the 2015 Physician Fee Schedule rule, which includes important information about how to receive reimbursement for Care Coordination services – a key component of an Accountable Care Organization.

There are important changes regarding the PQRS and Value-Based Modifier programs, as well as updated quality reporting requirements for the Medicare Shared Savings Program. Our short summary is available to download.

We will have a Webinar on November 11th at 10am PT via www.readytalk.com / 303.248.0285 / 5004777 to discuss these changes and answer your questions on the new rules.

Last Day to Comment!
Reminder: CMS has asked for comments on innovation in the Medigap and Retiree Supplemental Design. Using this PDF comment form, please enter your contact information on page 2 and answer question 13 on page 5 (my comments are included, please use your own words) and save the document.

Submit the form to HealthPlanInnovationRFI@cms.hhs.gov today, (due November 3rd).

Comments matter! Your voice will be heard.