New Rules, New Policies (And Old Time Hockey)…

The doc fix has become a Stragelove-ian script.

CMS is expanding the Pioneer ACO model

Good morning, ProviderNation. I’m sure you’re anxious about the mixed results from last week’s most important news in the history of last week, but just calm yourself for 17 seconds. Further, it has been exciting to watch, no? And if this series doesn’t lead to a Constitutional amendment against dump-and-chase, well, then I weep for the future.

Pioneer Rules

In other news, the fine folks at CMS are clearly in a hurry to expand its Medicare Shared Savings program. Late last week, the agency published a final rule that the Obama administration hopes will “encourage the delivery of high-quality care for Medicare beneficiaries and build on the early successes of the program and of the Pioneer Accountable Care Organization (ACO) Model. This final rule is an effort to provide support for the care provider community in creating a delivery system with better care, smarter spending, and healthier people.”

Among other things, CMS is hoping that the final rule will create a new “Track 3” program, which attempts to Xerox the Pioneer model by offering higher rates of shared savings, prospective assignment of beneficiaries, and new care coordination tools. CMS says the rule will also “streamline” the flow of information between ACOs and the agency, refine some of the benchmarks to offer strong incentives to improve patient care and save money, and offer a waiver of the three-day rule for ACOs that join the Track 3 program, CMS says.

The last matter is likely to get the most attention from provider types. The American Health Care Association’s invaluable James Michel says the waiver may be “the most significant change” for post-acute care providers.

“Under the new rules,” Michel says, “ACOs who opt into the new ‘Track 3’ of the program will be able to submit an application to CMS requesting a waiver of the three-day stay requirement. ACOs must identify their desired SNF partners up front in the application, and the partner SNFs also must submit a letter of intent that must be included with the application.

“Additionally,” Michel adds, “SNFs will be eligible to apply for the waiver with the ACO only if they meet certain criteria, including having an overall rating of at least three stars on Nursing Home Compare.”

The new rules for the waiver take effect at the beginning of 2017, Michel says, “to give CMS enough time to issue additional sub-regulatory guidance outlining in more detail how to apply for and implement the waiver.” Stay tuned.

AGS, LGBT, You And Me

Speaking of new ways of thinking, you may have seen that the fine folks at the American Geriatric Society have published a new policy statement on the care of aging gay, lesbian, bisexual, and transgendered people. It urges provider types to take concrete steps to make sure that everyone is treated equally while under their care.

The statement itself is hardly revolutionary. But, rather like the dog walking on its hind legs, what matters is that it’s happening at all.

“All points covered aren’t groundbreaking, but it is great that they have taken an official stand,” says the Great Dayne Duvall, chief operating officer of the National Certification Board for Alzheimer Care. “I’m also glad that they cited studies and resources, especially the Joint Commission, CMS, and Institute of Medicine.”

The society’s policy statement is pushing on an open door as far as the National Center for Assisted Living’s board chair, Pat Giorgio, is concerned. “We long term care providers pride ourselves on person-centered care, and we must do all that we can to truly embody that effort,” she tells ProviderNation. “Each unique individual in our communities, regardless of sexual preference or orientation, is a person we are committed to serve.”

For all of that, Duvall says there is an unanswered question: What’s to be done about those elders who aren’t quite, um, on board with LGBT? (After all, it was barely a decade ago that a majority of voters in several states were showing up to ban gay marriage.)

Duvall nonetheless sees a paradox coming: If providers commit to person-centered care, doesn’t that mean that care has to be delivered equally to those who don’t share the majority’s view of equality? Putting it another way, what does a care center do when an orthodox Christian asks not to be cared for by an LGBT staffer?

“Does he have that right?” Duvall asks. “I really don’t know. But I know that we, as a profession, better start having that conversation.”

Bill Myers is Provider‘s senior editor. Email him at myers@providermagazine.com. Follow him on Twitter, @ProviderMyers.

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Filed under Long term care, Post-acute care

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