Quality care model pegged as 'new frontier'

ATLANTA - As health care continues its shift from a quantity to quality care model, there's no simple answer as to how DME providers can make sure they're part of the picture, said attorneys at Medtrade on Monday.

“(Accountable care organizations) are like a Rubix cube—it's really complicated to put together,” said Matthew Agnew, an attorney with Polsinelli, during the session, “Establishing Referral Arrangements with Hospitals and Physicians through Quality Care Organizations: An Interactive Session.” “When you look at ACOs and the integration of DMEs, they are putting that cube together right. We want to get to that goal of having all the colors on the same side.”

ACOs, just one model under the larger quality care model, have the goal of incentivizing providers to save insurers money and, ultimately, sharing in any savings. Medicare must approve ACOs, which provides waivers to certain fraud-and-abuse laws that can protect them from the Anti-Kickback Statue and Stark Laws.

It's important to note, attorneys say: ACOs are not managed care, they are not insurance and they are not a physical location.

“ACO is a term that gets floated a lot, so understanding what these are is important,” said Rossanna Howard, an attorney with Brown & Fortunato.

When it comes to partnering with an ACO, consultant Anna McDevitt says it's not all that different than what providers already do.

“You develop the relationships the same way you developed referral relationships,” said McDevitt, CEO of Lab Tactical Consulting. “You have to have a connection with decision-makers.”

Providers also need to deliver value, and show that value to those decision-makers. That can take the form of patient satisfaction surveys and outcomes, McDevitt said.

“This is a new frontier for the industry,” she said. “You have an opportunity to jump on and help define some of these things.”