New fed loans to pro­mote ru­ral ACOs

Modern Healthcare - - NEWS - By Melanie Evans

The Obama ad­min­is­tra­tion plans to of­fer in­fra­struc­ture loans to small and ru­ral health­care providers to par­tic­i­pate in Medi­care’s pro­gram for ac­count­able care or­ga­ni­za­tions.

The ad­vances will fund cap­i­tal in­vest­ment and hir­ing at ACOs with fewer than 10,000 pa­tients that want to par­tic­i­pate in the Medi­care Shared Sav­ings pro­gram. In ad­di­tion to physi­cian groups, all crit­i­cal-ac­cess hos­pi­tals will be el­i­gi­ble for the pro­gram. The CMS also will con­sider ap­pli­ca­tions from hos­pi­tals with up to 100 beds.

The new pro­gram, called the ACO In­vest­ment Model, is ad­min­is­tered by the CMS’ Cen­ter for Medi­care & Med­i­caid In­no­va­tion, the pol­icy lab­o­ra­tory cre­ated by the Pa­tient Pro­tec­tion and Af­ford­able Care Act to test new ways to de­liver and pay for health­care.

ACOs that sign up for the new model would re­ceive a loan and ad­di­tional monthly pay­outs, which would be paid back with de­duc­tions from bonuses they earn un­der the pro­gram. The CMS is also of­fer­ing the loans to ex­ist­ing Medi­care ACOs that may be poised to exit. A num­ber of Pi­o­neer ACOs have dropped out of the pro­gram. The to­tal cost of ad­vance pay­ments is pro­jected to be $114 mil­lion.

Those that ap­ply must meet cer­tain el­i­gi­bil­ity cri­te­ria and agree to switch to the pro­gram’s higher-risk tracks, which ob­li­gate them to ac­cept po­ten­tial penal­ties along­side po­ten­tial bonuses start­ing in 2016 or 2017.

The agency is at­tempt­ing to ad­dress bar­ri­ers that pol­icy ex­perts say are pre­vent­ing med­i­cal groups in ru­ral com­mu­ni­ties from join­ing Medi­care’s test of ac­count­able care, which be­gan more than two years ago. Medi­care has ex­panded the ini­tia­tive each year, and the new cap­i­tal pro­gram will be avail­able to those seek­ing to join in 2016.

Cap­i­tal con­straints present “a con­stant bar­rier” for small, physi­cian-op­er­ated ACOs, said Larry Ko­cot, a vis­it­ing fel­low work­ing with the Brook­ings In­sti­tu­tion’s ACO Learn­ing Net­work.

Smaller hos­pi­tals also strug­gle to pay for IT beyond elec­tronic med­i­cal records, in­clud­ing soft­ware to an­a­lyze data and re­port qual­ity. “Just be­cause you have an EMR doesn’t mean you’re ready to be an ACO,” said Dr. Kavita Pa­tel, man­ag­ing di­rec­tor of clin­i­cal trans­for­ma­tion at the En­gel­berg Cen­ter for Health Care Re­form.

Cap­i­tal con­straints present “a con­stant bar­rier” for small, physi­cian-op­er­ated ACOs. —Larry Ko­cot, vis­it­ing fel­low, Brook­ings In­sti­tu­tion’s ACO Learn­ing Net­work

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.