You cannot pick up a newspaper, turn on a TV news broadcast or visit a news web site today without hearing stories about Congressional town hall meetings. Either they are invaded by Affordable Care Act supporters or they are being avoided by representatives who do not want to face those supporters.
Times of rapid change are rife with uncertainty, and loud voices. The uncertainty we are currently under is as hard on healthcare providers as it is on insurance purchasers. With all the Affordable Care Act's flaws, the Healthcare at Home industry is growing accustomed to it, and now it is at the epicenter of the change that was voted for in November.
When everything seems to be changing, grab onto an anchor, any anchor available. At last month's Compliance Conference, home care attorney Elizabeth Pearson calmed agency owner fears with a list of anchors to grab.
"Regardless of what the new administration changes," she stated during the last week of the Obama administration, "some things will stay in place. You can count on BPCI and ACOs, for example." (see sidebar)
According to the
CMS web site:
The Bundled Payments for Care Improvement initiative is comprised of four broadly defined models of care, which link payments for the multiple services beneficiaries receive during an episode of care. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality and more coordinated care at a lower cost to Medicare.
Calling BPCI "the future" and predicting that they will expand from Complete Joint Replacement surgeries to cardiac cases, Pearson reminded her audience that ACOs are still the present, still moving forward, and still looking for post-acute care partners.
"Next Generation ACOs seem to be the most popular," she observed. "They are still mostly found in population centers, such as the DC to Boston corridor, Los Angeles, Seattle, Houston and Miami (see map below), but they are worth watching. They virtually force hospitals to engage with post-acute providers."
She went so far as to say she can envision HHAs being asked to coordinate patient care through the pre-acute to post-acute continuum. "There are consultants specializing in creating bundles and attorneys specializing in guiding you through these partnerships. Even insurance providers are creating ACO-like groups of their own."
There are, however, some issues to watch out for, Pearson continued. Next Generation ACOs, for example, must serve a pool of at least 5,000 people. This may explain why they are appearing first in or near large cities (see map). When partnering, you will note that boilerplate contracts heavily favor the ACO. "Get your own counsel involved," she underscored. "Examine those contracts to see who writes care plans. Physicians who own these bundles have a fiduciary relationship with them. They serve their financial interest by controlling costs. We have seen blanket orders for 4-visit limits."
Dress up for the dance
Equally important, polish your reputation before jumping into meetings with ACOs. "They are only inviting 5-star agencies to the table," Pearson said her experience tells her. "You will be dealing with care transition specialists, often nurse practitioners, with their own agenda."
Also keep an eye out for "Accountable Health Communities," a $157 million CMS demonstration project experimenting with ways to bridge the gap between social services and health care.
The Future of Partnering
Physicians may own no more than 40 percent of the stock of a home health corporation with which that physician's ACO or bundle organization partners. That physician is also limited to providing no more than 40 percent of that partner HHA's referrals.
Everybody wants to know the bottom line. In this case it is twofold. "Change is the only constant." And read the new Conditions of Participation in the Federal Register.
©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org