The nation’s largest nursing home trade group is expressing “deep” concern about accountable care organizations following the Centers for Medicare & Medicaid Services’ announcement of an overhaul of the program.
Revisions to the ACO program will include expanded use of telehealth for practitioners, along with broadening of the SNF three-day waiver for certain providers, according to CMS’ fact sheet. Changes to the ACO program will take effect on July 1, CMS said, and are estimated to save Medicare $2.9 billion over the next 10 years.
American Health Care Association Senior VP of Reimbursement Policy Mike Cheek said the group appreciates the federal government’s recent moves to improve ACO design and operating structure, but they are troubled by attempts to curb healthcare utilization.
“The association remains deeply concerned about ACOs’ continued use of utilization management-like approaches, which they do not have the authority to employ,” Cheek told McKnight’s. “ACOs essentially are a managed fee-for-service delivery model but, in the real world, are operating as Medicare Advantage plans without the authority to do so and without oversight to protect beneficiary rights and access.”
Cheek gave the example of “significant downward pressure” being applied by ACOs to shorten skilled nursing facility lengths of stay, and reduce patient per-day costs. He added that the AHCA looks forward to working more closely with the Center for Medicare & Medicaid Innovation to develop “much-needed protections” for both beneficiaries and providers.
Other groups chose to focus on the positive, such as more flexibility for SNF stays. In a statement, Clif Gaus, chief executive of the National Association of Accountable Care Organizations, said his group supports the Medicare Shared Savings Program, “which has a track record of saving taxpayer hundreds of millions of dollars while demonstrably improving care for patients, continues to attract new participants and reap savings.”
“We appreciate CMS’ effort in the final rule to provide greater stability to the Medicare Shared Savings Program with five-year agreement periods and more flexibility through waivers for telehealth and skilled nursing facility stays,” he said.
