Value-Based Care News

Rural Hospitals Join Forces to Access ACO Incentives

By Ryan Mcaskill

The National Rural Accountable Care Consortium is helping rural hospitals transform the care they provide.

- With the healthcare landscape in the middle of a major evolution and embracing value-based care, solutions that embrace coordinated care are becoming more popular. Accountable Care Organizations (ACOs) are leading the charge and helping spur incentives and funding. The problem is that critical care organizations in rural areas often find themselves on the outside looking in, as they do not meet the criteria required to qualify for these incentives.

One way that rural critical access hospitals are positioning themselves to take advantage the new opportunities is by creating ACOs. The National Rural Accountable Care Consortium is helping these rural providers come together and move toward new models of care delivery that implement coordinated, patient-centered care to improve the quality of life for their community and reduce avoidable healthcare spending.

In an interview with RevCycleIntelligence.com, Lynn Barr, the Consortium Chief Transformation Officer and rural healthcare thought leader, spoke about the National Rural Accountable Care Consortium, why it was created and what the purpose of a new summit to help spread information.

According to Barr, the Consortium was officially started in 2013, but has been in the works for several years, since the HITECH Act was officially signed. Many providers upgraded systems like electronic medical records (EMRs), but found themselves say, “Okay, great, we have our EMRs, we are meaningful users, now what?” There were not programs for rural providers to go much further.

“We were looking at the data and the waivers and seeing how exciting it all was and we were missing out,” Barr said. “There were a number of providers that had applied to the program when it started and they all failed to get in. There were a couple rural IPAs out there that got in. All of us critical access hospitals were on the outside looking in. So we decided to put a bunch of hospitals together that are in noway affiliated, aside from wanting to get in on the program, submitted the application and got in.”

She mentioned that when these ACOs were created, the rural hospitals did not know each other, let alone have referral arrangements already in place.

“It is just an interesting twist on it,” Barr said. “That is how we have to work because most of these rural communities get about 1,000 beneficiaries assigned to them. So you have to aggregate them into this different model of collaboration. So that was the biggest piece, people couldn’t even get in.”

Since getting in, the consortium has learned lessons, both good and bad, when it comes to rural providers.

The good lessons include the fact that rural providers are often smaller and making change, whether small or large, has fewer obstacles. Most noticeably it is easy to get all the decision makers of a small hospital into a single room and start talking about and implementing changes.They are flexible and have great relationships with the community because they know these patients, in many cases, all of their lives.

The downside is that many of them are low on cash. The average day’s cash on hand for a critical access hospital is 69 days. In many cases they are opening the checkbooks and asking,”who do we pay today? Can we make payroll?” The problem is that join an ACO can be expensive, especially when it comes to IT and legal costs.

That’s why, according to Barr, the consortium not only pools together minds but also money, making it possible for more hospitals to take advantage of the money that is on the table.

National Rural Accountable Care Consortium Logo

This week, the consortium is running the first Rural ACO Summit, which is a free educational conference being held in conjunction with the National Rural Health Association”s Policy Institute. Batt said the consortium realized that many rural hospitals had great ideas and there needed to be an outlet for them to come together share them. This way care coordinator can talk to care coordinators, physicians can talk to physicians and CEOs can talk to CEOs, share stories and best practices and make it easier to succeed.

Aside from members of the consortium, prospective members are also able to attend, gather information and get involved in the discussion. Barr said that many CEOs are already thinking about this type of approach and now they have the platform to seek advice. However, there are a number of challenges that these organizations face.

According to Barr, this is a total transformation of the healthcare system that they are use to, so the challenges are enormous.

“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,” Barr said. “We want them to turn that around. 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. And wherever they go, we have their back.”

The first thing that needs to happen, is create these new service in the community: care coordination. It may be a huge transformation, but once it is up and running and the data starts coming in, it becomes much easier to move through the evidence based medicine.

“There is no program out there that had this,” Barr said. “It’sexciting. This is all created by these rural hospitals. We are just helping them organize it, but it is really being led by these nine rural communities that started this. These pioneers who said we just have to get in and we have to try. They took big risks and didn’t know what would happen.”

The second group of rural hospitals are just starting off in the consortium. They are in the implementation phase that means lots of backend systems and integration. It is the hardest part because there are little results. Once the data starts coming in and it is possible to compare performance with other hospitals, it is easier to understand why shifting to an ACO was the right decision.

“We just wanted to put the education out there,” Barr said. “There are hundreds of millions of dollars available. We assume that a lot of health systems will do this without us, and we hope they do, because we can’t possibly accommodate the 300 health systems they have funding for. We are just happy to share what we have learned and hopefully they will learn from our mistakes and hit the ground running harder than we did.”