- Under new Medicare accountable care rules, physicians have the option to send patients directly to nursing homes for skilled-nursing care, waiving the required three-day hospital visit formerly required for Medicare to begin paying for skilled nursing.
- The waiver goes into effect in 2017 and is limited to the newly-created Track 3. The homes must have at least three stars on Medicare's five-star rating scale.
- The new rule removes a check on the overuse of skilled-nursing care (reimbursed by Medicare at a higher rate than nursing home visits). Track 3 holds the highest financial risk—a key safeguard against overuse, say groups who urged the agency to limit the waiver to this track.
Right now, it's unclear how many ACOs will be able to take advantage of the waiver, since it looks like the majority of Medicare ACOs are probably going to avoid the higher-risk Track 3. Federal officials say that of the 220 ACOs with contracts expiring in December, around 90% will renew and "most" will avoid Track 3.
ACOs, the American Health Care Association and the nursing home industry all urged the CMS to extend the waiver to all ACOs. "It's an artificial barrier to you being able to get the patient to the best place for care the soonest," Paul Harkaway, MD, senior vice president for clinical integration and accountable care at Trinity Health, told Modern Healthcare.