SNF leaders wary of new ACO rule

Skilled-nursing facilities are seeking more say in how they contract with accountable care organizations as a new CMS rule for ACOs loosens the coverage policy for some Medicare patients, experts say.

Under the ACO Track 3 program, which starts in January, post-acute providers hope to see more gain-sharing opportunities, said Mike Cheek, a senior vice president at the American Health Care Association, which represents SNFs, nursing homes and other post-acute providers.

Effective in 2017, the new rule for Medicare's latest ACO model waives the required three-day hospital visit before Medicare will pay for skilled-nursing care, as long as patients go to SNFs with at least three stars on Medicare's five-star quality scale.

Cheek said his group has looked to the CMS for guidance on contracts between ACOs and SNFs to make sure gain-sharing can happen, but contractual language can be complicated. Some but not all contracts with ACOs are structured so that it's impossible for SNFs to receive revenue from gain-sharing relationships, he said.

Post-acute-care leaders are concerned that under the Track 3 program, hospitals alone will establish pricing for post-acute providers and will be solely responsible for structuring how services are delivered, said Robert Molitor, chief operating officer at the Alden Network, a Chicago-based SNF and post-acute provider. The current system is more collaborative in terms of decisionmaking, he said.

Cheek downplays worries that the CMS rule allowing SNF admissions without a hospital stay will lead to overuse of skilled-nursing care. But he expressed concern that there could be access problems in ACO markets where there are not an adequate number of SNFs with at least three quality stars from the CMS. Patients would then have to be sent to a post-acute setting that might not be right for them and could be more expensive, such as inpatient rehabilitation or home healthcare, he warned.