More on the accountable care front
Editor’s note: This article was written by guest blogger Anthony Cirillo, FACHE, ABC, a healthcare marketing and experience management expert and elder advocate. For more information about the author, please see our About page.
Atlantic Information Services’ Health Business Daily reported that at the Accountable Care Organization (ACO) Summit in Washington, D.C. on June 8, attorney Noah Rosenberg commented, “Everyone wants to form one, and they don’t know what it is, and neither do I.” Rosenberg is a former Health and Human Services general counsel.
The statute defines ACOs as provider-based organizations, comprised of multiple levels of providers and responsible for the full continuum of care, which are held accountable for the cost and quality of care and share in savings from it. The actual regulations should be out in late 2010 or early 2011.
Former CMS administrator Mark McClellan said implementation would be an “iterative process” as it was with Medicare Part D. So while regulations may be out as early as this year, providers may not be affected for many years.
At the American College of Healthcare Administrators conference in Philadelphia this May, a panel of experts urged their nursing home members to become more educated on the ACO concept. Here are a few problems in that regard. Right now, ACO’s are really being talked about in the Medicare sphere, and that is only one piece of long-term care reimbursement and not a large percentage, despite being a better payer (compared to Medicaid, that is). Also, most of the talk about ACO is really centered on physicians and hospitals.
So what is an organization to do? I would suggest that providers wait for the regulations to fall in place before taking some steps but act now toward certain initiatives. Care coordination is at the heart of ACOs. A physician office will be a microcosm and ground zero as it looks to implement the medical home concept. That coordination will be aided by electronic medical record but also through personnel that act as navigators. Geisinger is paying for extra nurses to act in this role even now. They are willing to spend more because they know where the market is generally moving.
Geisinger is a good example for nursing homes to follow. No matter where ACOs and reimbursement shake out, care coordination will be rewarded because, in the end, it will reduce healthcare costs through reduced re-admissions, medication errors, and duplicative testing. That coordination will reach into the long-term care space so, in the words of Rodney King, all players need to “get along.” That will call for better communication with your hospital neighbors but also with other care providers in the continuum. In some respects, heated competition must be replaced by mutual cooperation and sharing in the rewards. Progressive long-term care organizations will start approaching their colleagues in the continuum now to begin the conversation about ACOs, and these providers will be rewarded in the long-term.
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MacKenzie Kimball
MacKenzie Kimball is a Managing Editor in HCPro's long-term care division. She is the editor of the monthly newsletter PPS Alert for Long-Term Care and the MDS 3.0 Update e-newsletter.
MacKenzie has written 224 posts.
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