ACOs

Making a quality bet on ACOs a risky proposition

Making a quality bet on ACOs a risky proposition

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If there's anything that's become clear about this ACO business lately, it's that it's not going to be as simple as A-B-C.

Latest ACO dropout blames issues with payment system

Latest ACO dropout blames issues with payment system

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A California healthcare system recently became the latest dropout from the Pioneer Accountable Care Organization program, citing the fact that payments are not adjusted by region. Sharp HealthCare announced the move in its third-quarter financial report.

ACO bill in House would waive 3-midnight requirement for skilled nursing care

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Certain Accountable Care Organizations would be able to send Medicare beneficiaries to a skilled nursing facility without a prior hospital stay under a bipartisan bill recently introduced in the House of Representatives.

More programs drop out of Pioneer ACO pilot

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The Pioneer Accountable Care Organization program is now down to 19 programs, out of an original 32, worrying those who have pushed for skilled nursing facilities to embrace the concept.

No ACOs have reliable interoperability with external organizations, survey finds

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A widespread lack of interoperable technology threatens the Accountable Care Organization model, according to recently released survey results.

The end of fee for service

The end of fee for service

The seeds that have flowered into the burgeoning of ACOs - groups of providers accepting the responsibility, and risk, for caring for the health of a designated patient population according to defined quality benchmarks (CMS measures quality of care using 33 measures in four key domains) - was planted long ago, in the baby boom.

Preparing your back yard

Preparing your back yard

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SNF providers are scrambling to prepare to be "bought" by ACOs, aligned with potential bundling partners, selected as a preferred provider, and ultimately "sold" to the best, not highest, bidder.

Report: Complex care management can succeed, reduced Medicare SNF expenditures 64% in one instance

Report: Complex care management can succeed, reduced Medicare SNF expenditures 64% in one instance

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Well-designed programs to coordinate care for patients with complex needs can reduce Medicare expenditures, including skilled nursing facility costs, according to an issue brief released Thursday by The Commonwealth Fund.

Feds: Tie ACO ratings to SNFs

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Accountable care organizations should be assessed on which patients bounce back to a member hospital within 30 days of being discharged to a skilled nursing facility, the Centers for Medicare & Medicaid Services asserts in a proposed rule.

Skilled nursing facility trends contribute to improved Medicare outlook, Congressional report says

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The Medicare trust fund is on track to remain solvent until 2030, trustees of the program stated in a Congressional report released Monday. This improved outlook is due in part to revised expectations about the case mix in skilled nursing facilities.

'The Great Perhaps' in LTC

'The Great Perhaps' in LTC

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In post-acute care, particularly the SNF future, it can be "Great" but there are so many "Perhaps" that the definition of what "Great" is going to be is unclear.

 Skilled nursing facility readmissions should be an ACO quality measure, government proposes in payment rule

Skilled nursing facility readmissions should be an ACO quality measure, government proposes in payment rule

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Accountable care organizations should be assessed on the number of people who return to a member hospital within 30 days of being discharged to a skilled nursing facility, the Centers for Medicare & Medicaid Services has stated in a proposed rule.

 New payment models present opportunities for SNFs

New payment models present opportunities for SNFs

For skilled nursing facilities, the Medicare SNF 3-day rule can make it difficult to place the right patients in the right setting at the right time. The 3-day rule requires that a Medicare beneficiary spend three nights in a hospital as an inpatient — observation stays do not count — before becoming eligible for Medicare-covered SNF care. This rule creates a challenge for SNFs as hospital lengths of stay decline for many of the conditions that SNFs treat.

All ACOs should be allowed to waive 3-midnight requirement for Medicare skilled nursing coverage, MedPAC says

All ACOs should be allowed to waive 3-midnight requirement for Medicare skilled nursing coverage, MedPAC says

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Accountable care organizations should be able to place patients in skilled nursing facilities more quickly and communicate which SNFs are preferred providers, the Medicare Payment Advisory Commission stated in a letter to a top government health official.

New model of care presents new risks

New model of care presents new risks

Whether you're a long-term care leader who has already made the decision to align your organization with an ACO or are still in the process of weighing the decision, one thing everyone can agree on is this operating model will entail a significant amount of change in several key areas for participating long-term care providers.

Long-term care providers are participating in 'most ambitious test' of bundled payments, CMS announces

Long-term care providers are participating in 'most ambitious test' of bundled payments, CMS announces

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Skilled nursing facilities and home health agencies are among 232 healthcare providers that have entered into agreements to take part in the Bundled Payments for Care Improvement initiative, the Centers for Medicare & Medicaid Services announced Thursday.

Bipartisan bill proposes new provider networks to serve chronically ill seniors

Bipartisan bill proposes new provider networks to serve chronically ill seniors

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Skilled nursing and rehabilitation providers would be able to join networks dedicated to treating chronically ill Medicare patients, under a new bipartisan bill introduced Wednesday in both houses of Congress. The "Better Care, Lower Cost Act" seeks to establish the Better Care Program, which would enable healthcare providers to form networks similar to accountable care organizations, but with a special focus on coordinating care for those with chronic conditions.

Eliminating the "Black Hole": Transitions of care

Eliminating the "Black Hole": Transitions of care

In the early days of hospitalist medicine, we described the period between hospital discharge and follow-up at the skilled nursing facility, long-term care acute care hospital or a primary care physician as the infamous "Black Hole.

Providers that are extensions of hospitals will win in the ACO era, experts say

Providers that are extensions of hospitals will win in the ACO era, experts say

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Nursing homes and other post-acute providers should position themselves now as top-tier candidates for accountable care organizations, or they risk losing significant market share, experts said in a McKnight's webcast yesterday.

Outcome assessment and the Affordable Care Act

Outcome assessment and the Affordable Care Act

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Outcome assessment should be seen as a tool for change management and will likely become the new standard for assessing resident care under the Affordable Care Act.

Time is limited for ACO deals

Time is limited for ACO deals

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By negotiating now, a nursing home can have a strong voice in an Accountable Care Organization. Otherwise, ACOs will come to nursing homes in two or three years with a "take it or leave it" proposition, according to John Durso, a partner at the law firm of Ungaretti & Harris LLP and a McKnight's Expert columnist.

Nursing homes' strong negotiating position with ACOs will not last long, legal expert says

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Skilled nursing facilities that delay joining an Accountable Care Organization will likely be losers in the healthcare marketplace, according to John Durso, a partner at the law firm of Ungaretti & Harris LLP. Durso recently offered tips for nursing homes that are negotiating to join an integrated care network.

Savvy post-acute care providers are seeking creative partnerships with hospitals, experts say

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Post-acute care providers should be considering creative joint ventures with hospitals to best take advantage of evolving healthcare delivery and payment systems, healthcare finance and legal experts said Wednesday in an Avalere Health webcast.

National provider call: Tips on application process for Medicare Shared Savings Program

The Centers for Medicare & Medicaid Services will be hosting a national conference call on Tuesday for providers interested in applying to take part in the Medicare Shared Savings Program. The 90-minute session starts at 1:30 p.m. Eastern. The Shared Savings Program is designed to help provides take part in Accountable Care Organizations (ACOs). On Tuesday, experts will offer tips on completing a successful MSS Program application, and more info on ACOs.

State News

State News

A four-person review panel would have to approve civil malpractice lawsuits against long-term care providers before the claims could go to court, under a bill that recently passed the state senate in Kentucky.

Bundled payment groups should replace fee-for-service, physician pay commission says

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The current fee-for-service healthcare model should be replaced with bundled payment systems that encourage more coordinated care, the National Commission on Physician Payment Reform said in a report released Monday.

Data sharing a major benefit of bundled payment groups, Medicare administrator says

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Increased coordination among acute and post-acute providers has reduced rehospitalization rates, signaling that healthcare reform is working, a senior Medicare official told the Senate Finance Committee on Feb. 28.

HHS awards states $285 million to support formation of innovative care and payment models

HHS awards states $285 million to support formation of innovative care and payment models

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The Department of Health and Human Services will award $285 million for 25 states to innovate healthcare delivery and payment systems, the agency announced on Feb. 21. In many of these states, long-term care providers will take part in newly established multi-payer groups, such as accountable care organizations.

ACOs, bundled payment groups 'becoming the face of American medicine,' Sebelius says

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Accountable care organizations and bundled payment initiatives are harbingers of the future healthcare system in the United States, Health and Human Services Secretary Kathleen Sebelius said in a speech on Tuesday. Sebelius addressed the American Medical Association National Advocacy Conference in Washington, D.C.

Too much provider consolidation leads to higher healthcare costs, expert says

Too much provider consolidation leads to higher healthcare costs, expert says

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Healthcare providers are increasing coordination to reduce the cost of care, but overly zealous consolidation can actually end up costing more, an expert panelist said at a Monday briefing.

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