Accountable Care Organizations In Rural America

It is hard to ignore the increase in Accountable Care Organizations' (ACOs) popularity in urban America, but how do ACOs fit in rural America?

 

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Over the last five years ACOs have grown from 64 organizations covering 2.7 million beneficiaries to 838 organizations covering 28.3 million beneficiaries. This large increase in utilization of ACOs across the U.S. coupled with the potential repeal and replacement of the Affordable Care Act (ACA) has many rural facilities questioning how this change in the healthcare market could impact their facility.  Due to the costs and location associated with Critical Access Hospitals, they are not a likely target for ACOs as they have to be monitored closely when it comes to savings.

 

HRG's team of billing specialists have answered and compiled the top three questions they get about ACOs from facilities located in rural America.

 

Will I lose my patient base to an ACO? 

ACOs are different from an HMO (Health Management Organization) in that a patient is not limited to a provider or specific facility where they can receive care.  If your facility is located in a rural area and does not have close access to an active ACO, your patient base is likely not at risk.

Will my reimbursement change if my facility provides care to a patient that is part of an ACO that I am not a member of?

No. If you are not affiliated with an ACO but provide services to a patient that is, your reimbursement will be the same as if you provided services to a patient that was not affiliated with an ACO.

Should I join an ACO?

If this is a step you are interested in taking, do your research.

  • Understand the risks and rewards. There are many different types of ACOs. Some of them have a shared reimbursement risk while others have a one-sided reimbursement risk. 
  • Know how you will be compensated. Compensation can vary from fee-for-service to capitation and could result in delayed payment for services, unless specified in your agreement with the ACO.
  • Speak to facilities similar to yours that are currently part of an ACO. Some ACOs have seen improved patient outcomes coupled with cost saving,s and seem to reach all of the goals intended when the program was created. Some, however, do not meet the benchmarks set and are unable to continue as an ACO.
  • Understand your patient population. Understanding how to apply population management principles is key to success if entering an ACO.  

It isn't always easy knowing what is best for your facility or situation, that is where partnering with a centralized group of specialists,  experienced in helping like-sized facilities in similar scenarios, can be very beneficial.

About the Author

 

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Cassie Wise

SENIOR DIRECTOR CBO DIVISION FOR HEALTHCARE RESOURCE GROUP, INC. 

 

Cassie Wise's healthcare career began as an afterschool job at a rural hospital in the Inland Northwest. Fifteen plus years later she is leading one of the largest Divisions at HRG and possesses extensive experience with multiple Health Information Systems, Clearing house software, and EHRs, 

Cassie's Division provides CBO services to multiple facilities nationwide including: PPS & Critical Access Hospitals, Rural Health Clinics and Indian Health facilities.  She and her team provide their CBO partners with the AR tools and economic stability needed to focus on what is really important....caring for their communities. 

 

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