2016 may be the year that the accountable care organization concept lives or dies – and some experts are tying success to the adoption of telemedicine.
Writing in the National Law Review, noted healthcare attorneys Nathaniel M. Lacktman and C. Frederick Geilfuss II,of Foley & Lardner, LLP, say ACOs will be pressured in 2016 to increase quality and cost savings benchmarks, thus qualifying for Medicare incentive payments. They argue that telemedicine will help them reach those benchmarks.
"2016 may be the year of telehealth and ACOs," the two lawyers wrote.
The coming year will be crucial, Lacktmann and Geilfuss say, because the Centers for Medicare and Medicaid Services is intent on pushing more of the nation's 353 ACOs participating in the Medicare Shared Savings Program into alternative payment models. Only 27 percent currently receive any shared savings incentive payments from the government; CMS wants that percentage at 30 percent by the end of 2016 and 50 percent by the end of 2018, while also seeking to have the percentage of Medicare fee-for-service payments moved to value-based purchasing at 85 percent by 2016 and 90 percent by 2018.
"While CMS concluded ACOs did a good job in 2014, most ACOs did not perform well enough to reach their quality and cost savings benchmarks," the lawyers wrote. "Despite making significant investments in infrastructure and operations to create an ACO (whether Pioneer or MSSP), the majority of ACOs still need to move the needle further in order to enjoy the financial incentives of these programs."
That's where telemedicine comes into play. CMS and the Office of the Inspector General have included telehealth and remote patient monitoring among the MSSP's fraud and abuse waivers, confirming the "belief that 'coordinating care, such as through the use of telehealth, remote patient monitoring and other enabling technologies' is an activity reasonably related to the purposes of the (MSSP) and therefore is eligible for protection under one of more of the fraud and abuse waivers."
But while these technologies have been acknowledged as reducing fragmented or unnecessary care and excessive costs – to the tune of nearly $600 million saved in the Medicare program – only 20 percent of ACO programs are using telehealth or telemedicine technologies, according to a 2015 ACO survey conducted by the eHealth Initiative and Premier.
"Since ACOs have already made substantial commitments to improving quality and reducing costs in a comprehensive, integrated way, they are among the most obvious beneficiaries to harness the power of telemedicine," Lacktman and Geilfuss wrote. "With these new waiver provisions, CMS and OIG appear to be encouraging that ACOs strongly consider and incorporate telemedicine into their overall operations and services."
"The MSSP waiver regulations show that barriers to growth and innovation for telemedicine providers continue to lower," they added. "ACOs that capitalize on these waivers, and use telemedicine and remote monitoring technology, may see an improvement in their financial incentive payments at the end of the year."