Providers have professed gratitude for recent federal proposals to improve accountable care organizations’ design and operation. But efforts to limit healthcare utilization should be scrapped, said the American Health Care Association.
The Centers for Medicare & Medicaid Services issued revisions to the ACO program that will take effect July 1. The updates include expanded use of telehealth and broadened application of the SNF three-day waiver for certain providers.
But American Health Care Association Senior Vice President of Reimbursement Policy Mike Cheek said that while his group appreciates the federal government’s recent moves to improve ACO design and operating structure, it is 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 said. “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.”
ACOs are applying “significant downward pressure” to shorten skilled nursing facility lengths of stay, and reduce patient per-day costs, Cheek noted.
From the February 01, 2019 Issue of McKnight's Long-Term Care News
