Home Health & Hospice Week

Background: Last year's Affordable Care Act health reform law requires the Centers for Medicare & Medicaid Services to set up a "Shared Savings Program" to coordinate care among multiple providers -- particularly hospitals and physicians -- for fee-for-service beneficiaries. Accountable Care Organizations, consisting of hospitals, physicians, and other providers, will share in program savings for their designated group of benes.

A proposed rule CMS released March 31 specifies that ACOs would have to take on at least 5,000 benes for a three-year period starting as early as Jan. 1, 2012.

The rule takes aim mainly at fragmented hospital and physician care. "More than half of Medicare beneficiaries have five or more chronic conditions such as diabetes, arthritis, hypertension, and kidney disease," the Health and Human Services Department says on healthcare.gov. "These patients often receive care from multiple physicians. Afailure to coordinate care can often lead to patients not getting the care they need, receiving duplicative care, and being at an increased risk of suffering medical errors."

"For too long, it has been too difficult for health care providers to work together to coordinate and improve the care their patients receive," HHS Secretary Kathleen Sebelius says in a release. "Accountable Care Organizations will improve coordination and communication among doctors and hospitals, improve the quality of the care their patients receive, and help lower costs."

Hospital readmissions are a priority. "Nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days -- a readmission many patients could have avoided if their care outside of the hospital had been aggressive and better coordinated," HHS says.

Home care providers will have a vital role to play in coordinating patient care, especially post hospital, industry experts predict.

The fear: Providers worry that if they get left out of initial ACO groupings, they'll end up frozen out of referral streams. This fear may prove unfounded, since the program is still in its infancy, experts note.

And while ACOs that produce savings will share in those, ACOs that "do not generate savings can be held accountable" eventually, HHS says in a release. In other words, they'll end up subject to financial penalties.

Under the proposed model, CMS still would pay individual providers for care as usual. But the ACO structure eventually could lead to bundled payments, which has been a popular idea in recent years for both law- and policymakers.

CMS is taking comments on the proposed rule until June 6. A link to the rule is at www.cms.gov/sharedsavingsprogram/ -- scroll down to "Important Dates."