ACO rule polishing could mean good things ahead

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James Berklan
James Berklan

Federal health officials have signaled that they are intent on getting this accountable care organization thing right. 

The Centers for Medicare & Medicaid Services has released a draft rule that is a tacit acknowledgement that something needed to be done to plug a leaky bucket. Released Dec. 1, the rule clearly reflects a “We heard you” sentiment after the defection this fall of several more ACOs from the Pioneer program. This is the payment-sharing model that was designed to entice and reward top performers.

All fingers are crossed that the proposal will turn out as positive as it first seemed.

As part of it, CMS asked for comments on how waivers of the three-day inpatient rule should be granted. This is a very good sign because it seems to indicate that it's a given that many more waivers will be granted, just not automatically.

LTC lobbyists should now be at their height of crafting impactful comments on this. They have until the first week of February to submit them.

Anything that would lower ACO care costs, such as cheaper SNF placement, should make all team members — including hospitals and physicians — happy. Under the proposed rules, hospitals also would still get to control which patients get to go to SNFs. This continued “gatekeeper” role also should help keep them happy.

Regulators notably also have proposed a third risk track, which ostensibly was created to keep providers from dropping out of ACO efforts altogether. They'd like providers to assume more downstream risk — and they're offering greater rewards for those who would do so — but they also are saying that one doesn't have to be particularly daring to remain a part of the ACO movement. In what appears to be a major victory for providers, ACOs would no longer be forced into assuming more risk after three years in the program.

If there's anything unsettling for LTC providers about the new proposal, it's that more guidelines on how to develop networks were not included. We should expect to see lobbyists push for more targeted guidance on how would-be partners from acute care should evaluate long-term care and other post-acute providers.

Currently, the networks can place emphasis on differing sets of standards. That leaves post-acutes unsure as to whether they're focusing on the right things to gain entry into the ACO club. And that ain't right.


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