Lynn Barr, CEO of the National Rural ACO, says her organization has developed a program that allows rural health clinics, federally qualified health centers, and hospitals to join an ACO regardless of size and with no downside risk under a bonus program. But time to get that money is running out.
Rural providers have only until May 1 to apply for a share of the $114 million in one-time federal grants to help the transition to accountable care organizations.
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Lynn Barr |
Lynn Barr, CEO of the National Rural ACO, which is administering the program, says that even though the deadline is one week away, it's not too late to file a letter of intent to join NRACO.
"Oh my gosh! You'd be amazed how many people don't know about this," Barr says. "This opportunity has flown under the radar. We're trying to get the story out."
"The LOI is a form on our website. That's five minutes and it is non-binding. It gets you into the process, and then you've got 60 days to review and complete the application," she says. "The application is not like an essay test. It's 'give us your tax ID numbers and review and sign the contracts that were mandated by (the Centers for Medicare & Medicaid Services).' People can totally do this."
Pioneer ACOs Saved Medicare $118 Million in Year One
Once a provider is inside the 60-day window, the process becomes freighted.
"There is a $25,000 deposit they have to put down with the application, which is earnest money," Barr says. "CMS wants to make sure people are serious and that they don't send in an application without board approval or whatever. But it is fully refundable. They get the money back."
Barr expects that about 150 rural providers will apply for the grant money, which provides between $1.4 million and $2.5 million per ACO, depending upon the size of the patient population it hopes to serve. To qualify, 65% of the providers in the ACO have to practice in an area with a (Rural-Urban Commuting Area) code above 4.0.
On Monday, 12 providers submitted LOIs to NRACO and Barr says "there are a lot of people who've told us they are going to get us letters, but they haven't done so yet. People tend to wait until the deadline, but we've gotten a lot already."
Barr says the grants are large enough to incentivize fence-sitters who might otherwise wait a year or two and allow more adventuresome providers to make the potentially costly rookie mistakes. There is also no guarantee that the funding will be re-allocated beyond 2016.
On Cash as a Barrier to Entry
"It's a one-time grant," Barr says. "For people who sign up with us, that is worth almost $400,000 for each site [within an ACO]. That's been the biggest barrier for people to join, the cash. CMS will fully fund their participation, so why not take advantage of it?"
The recent permanent repeal of the sustainable growth rate formula reemphasized that future Medicare payments are going to be based in large part on cost and quality. "You have to get into a program that will work on that," Barr says. "This will help identify cost issues, work on quality, develop networks and be ready for the new payment model."
Meet NRACO
If you're in rural health and you're not familiar with NRACO, consider this an introduction.
The group was formed in 2013 by nine rural hospital CEOs from California, Michigan, and Indiana who got tired of waiting for someone else to address the challenges that rural providers face transforming away from fee-for-service and toward population health and value-based care.
The consortium has grown in the last two years and now includes six ACOs comprised of 30 community health systems in nine states, with more expected to join in 2016.
NRACO acknowledges that size, location, and funding are definitely challenges for rural providers who want to transition to ACOs. However, Barr says NRACO has developed a program that allows rural health clinics, federally qualified health centers, and hospitals to join an ACO regardless of size and with no downside risk under a bonus program only that does not affect fee-for-service payments or cost-based reimbursement.
Barr is persuasive. Talking to her reminds me of the old Dale Carnegie technique of methodically "removing the objections" to make the sale. It's imperative that rural providers take on the ACO challenge because payment models are changing, she says, and the challenges surrounding this transformation will only become more daunting for providers who delay. So, why delay?
Talking to Barr also reminds me of another old saying: If you're not at the table you're on the menu.
"Rural providers have to engage with CMS to figure out now we are going to get paid," Barr says. "These payment models aren't perfect, but if we work with CMS we will help develop a program that will work for us. But we have to be in it to win it."
John Commins is the news editor for HealthLeaders.