How Data and Technology Are Strengthening the Relationships Between Accountable Care Organizations and Skilled Nursing Facilities

MedCity News | August 5, 2024

As the post-acute care industry continues transitioning towards a value-based care system, skilled nursing facilities (SNFs) should start to consider participating in an Accountable Care Organization (ACO) to not only help in achieving optimal outcomes but improving patient care journeys uniformly. Building a clinically robust continuum of care includes long-term acute and post-acute care hospitals and providers collaborating effectively. Even though only a small percentage of patients require care in post-acute settings, this number is growing, with the volume of referrals to skilled nursing facilities (SNFs) having grown more than 10% in the last two years. These patients also often require the most complex and costly care, accounting for nearly $60 billion of annual Medicare spend, putting them at a higher risk for readmission, as they often suffer from multiple chronic conditions and have the greatest need to be treated by practitioners and specialists on an ongoing basis.

How CMS Proposed ACO Advance Payment Policies Could Impact Palliative Care

Hospice News | August 2, 2024

The U.S. Centers for Medicare & Medicaid Services (CMS) has proposed a new avenue of funding for Accountable Care Organizations (ACOs) with implications for palliative care providers. The agency’s 2025 Physician Fee Schedule proposed rule contains a provision that would establish a new “prepaid shared savings” option for Medicare Shared Savings Program (MSSP) participants. This would allow ACOs with a history of generating savings to make greater investments in services, improving care coordination, hiring staff and building out health care infrastructure. This proposed policy dovetails with the Advance Investment Payment (AIP) component of CMS’ ACO Primary Care FLEX payment model demonstration. The AIP includes a one-time, $250,000 advance payment to help cover some of the costs of forming an ACO when appropriate, as well as administrative costs associated with the model. This can include investments in new technology for more robust data collection and analysis. The proposed rule and ACO Flex aim to use similar methods to address two different issues, according to Anna Basevich, senior vice president of enterprise partnerships and customer enablement at the data analytics firm Arcadia.

NAACOS worries new ACO REACH changes could force exits

Fierce Healthcare | August 2, 2024

The Centers for Medicare & Medicaid Services (CMS) quietly released changes to the ACO REACH Model, prompting one industry group to react to the modifications. The National Association of ACOs (NAACOS) said it is still digesting the changes and listening to members’ initial thoughts. “I think it’s a bit mixed,” Aisha Pittman, senior vice president of government affairs for NAACOS, said of the changes in an interview with Fierce Healthcare. Some of the changes—like removing expenditures for two catheter codes impacted during a $2 billion fraud scheme—were met with a positive reception from the industry group. The organization is still evaluating the effects of technical benchmarking changes.

Three Important Updates Impacting ACA Compliance

Edifecs | August 1, 2024

The Department of Health and Human Services (HHS) regularly refines its policies and operational guidelines in an ongoing effort to better serve patients and support sustainable value-based care delivery. To that end, HHS and CMS recently announced three important updates: [1] Revisions to HHS risk adjustment model algorithm software [2] Changes to cost-sharing reductions (CSRs) [3] Deployment of EDGE 38.0 These refinements are intended to improve access to affordable care and enhance the efficiency and accuracy of risk adjustment & risk adjustment reporting in ACA programs. In this article, we’ll take a closer look at the most relevant pieces of these three major updates.