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.
- by February 6th. Download our CMS comment letter here.
- 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.
- Join us. The National Rural ACO. Your seat at the table. Your path to a sustainable future.