CMS Moves Forward with New Arrangements for Medicare Providers

i May 1st No Comments by

Last week, CMS released information on a set of five new voluntary Accountable Care arrangements for Medicare PPS providers. Fact sheets and descriptions of each of the programs are provided on the CMS website. In a conference speech, CMS Administrator Seema Verma outlined the new program and noted thatLooking forward, you can expect that some of the models we have under development will be mandatory. One reason for mandatory models is that selection effects can be significant in voluntary models.  Selection effects happen when only the providers who would benefit financially from a model choose to participate, thereby reducing the amount of savings that the model can generate. Requiring participation also helps us understand the impact of our models on a variety of provider types, so the data resulting from the model will be more broadly representative.”

The arrangements are broken into two categories termed Primary Care First and Direct Contracting. The Primary Care First models can be implemented with as few as 125 Medicare patients. Note that the models may be limited to selected regions of the country. The Direct Contracting models are more varied, but may also have applicability in rural health systems. Both sets of arrangements are planned for the future, with many of the details still to come. Participants will be selected for a development year – 2020 – with implementation of the model in 2021.

Harvey Licht of Varela Consulting shared some insight with NOSORH leaders stating that “The primary care focus of this arrangement makes it particularly applicable to rural health systems. The two alternative Primary Care First arrangements may have wide applicability. Basically, the approach is to make a global primary care payment per patient and then to provide additional bonuses based upon specific cost and health quality outcomes. There is also a risk-bearing component, placing providers at some level of financial risk for failure to achieve outcomes. The financial risks appear to be more limited than the current risk-bearing ACO arrangements.”

The NOSORH staff, committees and partners are planning resources and education for State Offices of Rural Health and their stakeholders. The NOSORH Policy and Program Monitoring Team meeting on May 22nd at 3 PM eastern will provide a discussion forum for SORH.

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NOSORH Committee Spotlight – Policy Program Monitoring Team

i Apr 7th No Comments by

The Policy Program Monitoring Team (PPMT) Committee was established in 2011 to bring together NOSORH members, who were at the time, involved as co-chairs of the HIT, workforce and Flex committees.  The intent of the PPMT committee is to explore hot topics, and determine if:

  1. It has a policy focus, which is then referred to the Policy committee;
  2. It is something to be shared with NOSORH membership via a webinar, which is then facilitated through the Education Committee; or
  3. It requires further work, which then may need to be done by establishing an ad hoc group to do a deeper dive, such as the Rural Integrated Service System (RISS) work group.

According to co-chair Lynette Dickson, “Serving on this committee, has allowed me the opportunity to be informed on current issues, that may or may not impact my state specifically, but allows us to determine how to best keep our members informed on a topic that they may not have the time or resources to investigate themselves.”

Among the topics reviewed in the PPMT were the following:

  • Implementation of the Medicare Hospital Readmission Reduction Program (MHRRP) and its impact on rural hospitals. This topic became the focus of a webinar and a session at the NOSORH annual meeting. Each state received a profile of the MHRRP impact on its rural hospitals.
  • Implementation of the Medicare Hospital Value-Based Purchasing Program (HVBPP) and its impact on rural hospitals. This topic also was the focus of a webinar. States received profiles of the impact of HVBPP on rural hospitals.
  • Frontier and Remote (FAR) area designations as proposed by ORHP/USDA. The different iterations of this designation were monitored, with emphasis on the potential impact on currently designated frontier areas. The review of this topic led to NOSORH co-sponsorship of several briefing sessions on the topic for a broad audience.
  • Urban/Rural Premium Levels of Qualified Health Plans. This comparison became the basis of an information briefing for NOSORH members.
  • Review of Essential Community Provider (ECP) requirements for Qualified Health Plans. This review explored the potential impact of CMS ECP rules on how rural ECPs. Possible questions for NOSORH comment were forwarded to the Policy Committee.
  • In March 2015, the PPMT hosted a webinar on health system reform with participation from a variety of interest rural health partners. Click here to view the recording.  NOSORH Executive Director, Teryl Eisinger, referred to this webinar as a “great discussion with valuable sharing by all who participated.”

The PPMT is supported by Harvey Licht of Varela Consulting.  Mr. Licht provides the invaluable education on these issues of importance to SORHs.

For more information on the PPMT Committee or to join the Committee, please contact co-chairs Lynette Dickson (ND) or Pat Carr (AK).


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Webinar: Rural Input for Health Care Payment Learning and Action Network (3.26.15)

i Mar 31st No Comments by


Viewable Recording


NOSORH to Host Discussion on HHS Initiative Focused on Health Care Delivery System Reform

i Mar 2nd No Comments by

With the release of HHS Secretary Sylvia M. Burwell’s announcement on a major new HHS initiative focused on health care delivery system reform, NOSORH is hosting a call for SORHs on March 26th at 4:30 PM to discuss how to move the Medicare program, and the health care system at large, toward paying providers based on the quality and to share ideas and information from their states.  Join Policy Program Monitoring Team Committee (PPMT) Chairs Lynette Dickson (ND), Pat Carr (AK) and Harvey Licht to provide feedback on key rural issues for the Learning and Action Network.  We encourage all SORH to share the information with rural providers in their state and have prepared an article with more details for you to “steal” for your newsletters.  For more information, click here.


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