Accountable Care Organizations Renew Hospital Reimbursement
Accountable care organizations may benefit revenue cycle management, especially for the rural hospital community. Critical access hospitals may even become profit centers.
By - Accountable Care Organizations (ACOs) may be a welcome hospital reimbursement innovation for the critical access community. Critical care organizations far away from the hustle and bustle of a nearby city face a different set of reimbursement challenges. A critical access hospital with fewer than 10 patients to a single facility is reality.
Whereas one critical access hospital – i.e. Millinocket Regional in rural Maine – may be handling reimbursement matters via a somewhat discombobulated manual sticker system, another – i.e. Massachusetts General Hospital in Boston, may be more focused on the arduous task of simply cutting large programs down to size.
Last year, The National Rural Accountable Care Consortium attempted to help healthcare providers transition to the value-based care movement and reduce avoidable healthcare spending by granting rural hospitals greater access to ACO incentives.
“All of us critical access hospitals were on the outside looking in,” stated Lynn Barr, Consortium Chief Transformation Officer, to RevCycleIntelligence.com.
“Picture the world today, where I have a hospital and a clinic and if people are sick they are going to come in and see me, they might be able to get an appointment, they might not. Or they might drive by and decide to go someplace else because the clinic is closed so they head into the city.”
“We want to be there for primary care, no matter what. We want to get you an appointment, put in an advice nurse, set up care coordination, start looking at your claims and your records and find people that are sick and we are going to call them and we’re going to help them.”
Reading between the CMS ACO lines: a chat with Dutch Dwight
CMS recently announced 121 new Medicare ACO participants, including the Medicare Shared Savings Program, the ACO Investment Model, and the Next Generation ACO Model.
Of the new participants, 100 joined the Medicare Shared Savings Program. Thirty-nine Shared Savings Program ACOs will participate in the ACO Investment Model, CMS confirmed.
“These are some of the original ACOs that have made strides regionally – which is a very important component for success," said Dutch Dwight, Medullan’s Vice President of Business Development, in a personal interview with RevCycleIntelligence.com about why ACOs benefit the rural hospital community's revenue cycle.
“The re-evaluation by CMS is evident in their messaging: ‘test the use of pre-paid shared savings to encourage new ACOs to form in rural and underserved areas and to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk.’”
“Critical access hospitals can now potentially become profit centers while serving their constituents, versus consistent centers for losses. This change will create opportunities to innovate in these regions in such great need.”
Dwight confirmed the vast majority of these entities are not wirelessly enabled, reachable solely via landline. Telemedicine, he said, is far from an “Internet of Things” solution.
“These critical access hospitals could become the true test beds for innovation and investment. These patients want to be touched. They are not adverse to relationships with people. The more you touch these patients and help them, the more they will respond and the lower the cost of care will be."
