Home Care, Hospice Components Add Competitive Edge in ACO Bids

Post-acute care providers with home care and hospice components will be head and shoulders above the competition among those looking to partner with hospitals as part of an Accountable Care Organization (ACO), said two healthcare lawyers.

“Going it alone will no longer be a viable long-term strategy,” said John Durso, JD, partner at law firm Ungaretti & Harris, at a Life Services Network session last Thursday. “If you’re not part of an ACO, your patient base is probably going to shrivel up, at least on the Medicare side.”

Right now is an ‘exciting’ time to be involved in post acute care organization as there’s increased focus on the relationships between hospitals and other organizations in the care continuum and the synergies that can be created, said Jonathan Brouks, an associate at Ungaretti & Harris’ Healthcare Group.

“Now, [the hospital industry] is starting to think more longitudinally, figuring out, ‘How can we continue to care for these patients after they leave our walls?'” Brouks said during the session. 

Penalties for hospitals with 30-day readmissions above a certain threshold for heart attack, heart failure, and pneumonia patients will go up to 3% of total Medicare reimbursements by 2015 under the Affordable Care Act. For some acute care providers, that could translate to a “very large” amount, Durso says.

The push to partner with post-acute providers is becoming more urgent, and skilled nursing facilities are competing to be chosen for ACO participation. Senior care providers with home care service lines will boost their attractiveness to hospitals.

Providers want to be able to tell prospective partner hospitals that they’re able to manage an entire population, including home care, hospice, or care coordination, Durso says.

“If you think about it, where do residents want to stay? For many cases, the biggest competitor is the home,” he says. If a skilled nursing provider has its own home care service, “That’s most likely where [hospitals] are going to go,” he says. “That’s another reason why home care is really, really important.”

Written by Alyssa Gerace

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