Elizabeth Hogue’s Series on ACOs: The Role of Post-Acute Providers (Part IV)

Section 302 of the Affordable Care Act includes provisions related to Medicare payments to providers of services and suppliers that participate in Accountable Care Organizations (ACOs). Providers of services and suppliers who participate in ACOs will continue to receive payments under Parts A and B of the Medicare Program, but will also be eligible for additional payments if they meet certain requirements related to quality of care and cost savings. The Secretary of the U.S. Department of Health and Human Services has published final regulations establishing ACOs as early as April, 2012.

As indicated above, ACOs will share in cost savings if they meet performance standards for both quality of care and cost savings.  Specifically, there are thirty-three required quality measures for use in establishing performance standards that ACO’s must meet in order to share in savings for at least the first year of three years.

Performance criteria include measures related to Care Coordination/Patient Safety as follows:

  • Risk-Standardized, All Condition Readmissions
  • Ambulatory Sensitive Conditions Admissions: Chronic Obstructive Pulmonary Disease – AHRC Prevention Quality Indicator (PQI) #5
  • Ambulatory Sensitive Conditions Admissions: Congestive Heart Failure – (AHRC Prevention Quality Indicator (PQI) #8
  • Medication Reconciliation: Reconciliation After Discharge From an Inpatient Facility
  • Falls: Screening for Fall Risk

Hospital discharge planners/case managers will undoubtedly play a key role in achieving success on the above performance measures. In order to succeed, they must establish and maintain effective working relationships with post-acute providers of all kinds who can assist them to meet the above goals. The crucial role of post-acute providers to the success of ACO’s must be immediately recognized and acted upon by providers that wish to establish them.

This material is provided to HCAF by Elizabeth E. Hogue, Esq. Contact by phone at (877) 871-4062, fax at (877) 871-9739 or email at elizabethhogue@elizabethhogue.net.

© 2010 Elizabeth E. Hogue, Esq.  All rights reserved. No portion of these materials may be reproduced in any form without the advance written permission of the author.

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