SNF lead­ers wary of new ACO rule

Modern Healthcare - - BY THE NUMBERS - By Michael Sandler

Skilled-nurs­ing fa­cil­i­ties are seek­ing more say in how they con­tract with ac­count­able care or­ga­ni­za­tions as a new CMS rule for ACOs loosens the cov­er­age pol­icy for some Medi­care pa­tients, ex­perts say.

Un­der the ACO Track 3 pro­gram, which starts in Jan­uary, post-acute providers hope to see more gain-shar­ing op­por­tu­ni­ties, said Mike Cheek, a se­nior vice pres­i­dent at the Amer­i­can Health Care As­so­ci­a­tion, which rep­re­sents SNFs, nurs­ing homes and other post-acute providers.

Ef­fec­tive in 2017, the new rule for Medi­care’s lat­est ACO model waives the re­quired three-day hos­pi­tal visit be­fore Medi­care will pay for skilled- nurs­ing care, as long as pa­tients go to SNFs with at least three stars on Medi­care’s five-star qual­ity scale.

Cheek said his group has looked to the CMS for guidance on con­tracts be­tween ACOs and SNFs to make sure gain-shar­ing can hap­pen, but con­trac­tual lan­guage can be com­pli­cated. Some but not all con­tracts with ACOs are struc­tured so that it’s im­pos­si­ble for SNFs to re­ceive rev­enue from gain-shar­ing re­la­tion­ships, he said.

Post-acute-care lead­ers are con­cerned that un­der the Track 3 pro­gram, hos­pi­tals alone will es­tab­lish pric­ing for post-acute providers and will be solely re­spon­si­ble for struc­tur­ing how ser­vices are de­liv­ered, said Robert Moli­tor, chief op­er­at­ing of­fi­cer at the Alden Net­work, a Chicago-based SNF and post-acute provider. The cur­rent sys­tem is more col­lab­o­ra­tive in terms of de­ci­sion­mak­ing, he said.

Cheek down­plays wor­ries that the CMS rule al­low­ing SNF ad­mis­sions with­out a hos­pi­tal stay will lead to overuse of skilled- nurs­ing care. But he ex­pressed con­cern that there could be ac­cess prob­lems in ACO mar­kets where there are not an ad­e­quate num­ber of SNFs with at least three qual­ity stars from the CMS. Pa­tients would then have to be sent to a post-acute set­ting that might not be right for them and could be more ex­pen­sive, such as in­pa­tient re­ha­bil­i­ta­tion or home health­care, he warned.


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