ACOs Spell 'Opportunity' for HMEs
Under the Affordable Care Act, physicians, hospitals and other providers can form ACOs that work together to coordinate care for Medicare beneficiaries. Such networks will be expected to improve the health and experience of beneficiaries and reduce the growth rate of health care spending. In return, the networks will share in any savings to the Medicare program, which are anticipated to tally upwards of $430 million over three years.
In addition, the Advance Payment ACO model will allow certain ACOs participating in the Medicare shared savings program to access their savings up front as a way of covering the costs of infrastructure and staffing. CMS is asking for comments on that idea, and the agency's Innovation Center is offering learning sessions to teach providers about ACOs, as well as ideas for improving care delivery.
Form your own loose network, aligning yourself, say, with an infusion company and a home health agency for an "all-encompassing" home health care network. This is especially advisable for smaller HME businesses, Morris said, because it allows them more leverage. He noted that VGM is working on creating a network for its members that would establish connections with various ACOs.
Offer a health-coaching program. In addition to providing the equipment to help keep patients out of the hospital, offering a health-coaching program that enhances a patient's health and lifestyle is a value-added service, Morris said. While such a service is not reimbursable, it does give HME companies an advantage over their competitors. As the industry has seen in Round 1 of competitive bidding, referral sources in this case, the ACOs tend to call on the HME companies able to provide the most services.
"If ACOs are going to spend the money, it has got to reach beyond their Medicare population," he said. "They are going to go to the DMEs with all of their patients, not just some of their patients, and that will be beyond the Medicare market." So an HME company's reach could be expanded greatly and that could be a benefit when competitive bidding comes to communities nationwide.
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And, since almost every Republican in the House -- and now the Senate -- has voted for such drastic changes, Democrats across the country are happily learning how they can campaign to win back the House and keep the Senate. But we can't let Democrats
CMS is asking for comments on that idea, and the agency's Innovation Center is offering learning sessions to teach providers about ACOs, as well as ideas for improving care delivery. At this point, CMS doesn't recognize DME companies as network
Author Affiliations: Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Washington, DC. Corresponding Author: Donald M. Berwick, MD, MPP, Centers for Medicare & Medicaid Services, US Department of Health and Human
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