“The way (the CMS) assigns beneficiaries is kind of prejudicial to rural providers,” says Lynn Barr, strategic adviser to the group. “There's no way for us to participate—it's very, very frustrating.”
The National Rural ACO will provide centralized services, such as building a data warehouse for participating providers. Participants will not undertake any capitation risk and will continue to be paid on a fee-for-service basis. They will, however, be eligible to share in any Medicare savings, but without penalty if costs exceed the budget targets.
Barr says rural health providers already coordinate care and provide social services for people in their communities. “The strength we have is our relationship with patients,” she says.
But resources are the limiting factor.
Terry Hill, executive director of the National Rural Health Resource Center, which has partnered with the National Rural ACO, says even more than the expense of purchasing an EHR system, rural providers struggle with a shortage of experienced HIT professionals they can bring on board. In addition, a small hospital can't get the discounts offered to large providers.
And that means rural hospitals need to pool their resources, either formally through a merger or informally through a looser alliance. In Minnesota, for instance, roughly 20 hospitals are tapping into the expertise of a cooperative of 70 IT professionals who work with providers throughout the state. “Collaboration is such a necessary component,” Hill says.