Providers seek inside track with hospitals

Sunday, September 25, 2011

YARMOUTH, Maine - The details on accountable care organizations (ACOs) are still being hammered out, but savvy providers are already piloting new programs aimed at helping hospitals reduce readmissions.

"There are two pools of folks that are going to be able to help hospitals: HME providers or home health agencies," said provider David Hartley, CEO of Indianapolis-based Home Health Depot.

The Affordable Care Act of 2010 included a provision that provides an incentive to hospitals and physicians, working together as ACOs, to keep patients out of the healthcare system as much as possible. HME providers aren't specifically included in ACOs, but there's a place at the table, say stakeholders.

"This is a new opportunity for (providers) to bring cost savings to their referral sources," said Alan Morris, director of alternate care programs for the VGM Group. "They have the opportunity to help hospitals save money."

Enter providers like Hartley, who is currently working with a couple of hospital systems on two pilot programs. The first is a transitional care program, in which a care manager meets with the patient and caregivers prior to discharge. Those meetings are followed by home visits and weekly telephone "touches." The second program is a chronic disease management program that focuses on monitoring patients with COPD, congestive heart failure and heart disease. 

"In both cases, this is to help prevent readmits and emergency room visits," said Hartley. "It allows the hospital to have a better system in place to help that patient ahead of time, which is a lot less expensive."

Beginning Oct. 1, 2012, it's going to get even more expensive for hospitals that have high rates of avoidable readmissions for patients with conditions like pneumonia and CHF. They will see their Medicare payments reduced.

"Hospitals are going to get dinged," said provider Stacey Murphy, vice president of corporate development for AmeriCare Medical, which in August launched its own pilot program (See related story).

Providers who can do that will be ahead of the curve, says Morris.

"Hospitals are going to be willing to pay for these (services)," he said. "They have financial gain if these work."

While HME providers aren't currently able to charge for these services, they expect that to change in the not-so-distant future.

"In five or 10 years, this will be as commonplace as ordering a bed," said Hartley. "CMS and private insurance will begin to see tangible savings, and there will be a procedure code. We're in the very beginning stages."