EARH moves forward with joining an ACO

During a special meeting of the Adams County Board of Commissioners Hospital District No. 2 on May 4, the three commissioners present made the decision for East Adams Rural Healthcare to join an Accountable Care Organization (ACO).

At the regular meeting of the Board of Commissioners, two commissioners were absent and the determination was to not move forward with the decision until their opinions were taken into consideration.

The two commissioners, John Kragt and Ross Heimbigner, attended the special meeting with Chairman Eric Walker.

Commissioners Stacey Plummer and Jerry Crossler were unable to attend the special meeting due to previous commitments.

The ACO the District is joining is provided through Caravan Health, and the ACO will begin in January 2019. By making the early deadline with the special meeting, the District saved $2,500 in sign-up fees for early registration.

The initial projection is for the District’s net income to increase by $156,000 over the next three years. The ACO agreement is a three-year contract through Caravan Health.

During the April 26 meeting, CEO/CFO Gary Bostrom voiced his support for joining an ACO, but as an accountant, he believed it was a breakeven situation for the District.

Walker explained as part of the ACO, each participating hospital is responsible for individual recording of Medicare patients and the ACO serves 5,000 lives. Through Caravan Health, EARH would join with hospitals within the region.

Walker explained he believed the commissioners had as much information possible to proceed with the decision instead of prolonging the process.

He added none of the commissioners had contacted Bostrom electronically with questions after the initial meeting as requested.

Kragt clarified that while no commissioners sent questions via email to Bostrom, all of the commissioners contacted him directly with questions or clarifications regarding joining an ACO.

He added Bostrom is in favor of joining an ACO, it is the commissioner’s responsibility to recognize his recommendation, as that is what they pay him for.

Heimbigner stated he believed EARH needed to join an ACO because if they waited, they would be a year behind.

CNO Jennifer Pepperd provided insight regarding ACOs for the commissioners present, explaining an ACO is focused predominantly on preventative care for Medicare patients.

The local District is limited by the number of lives, and Pepperd estimated EARH accounted for around 200 lives, which are counted by the amount of Medicare patients who visit a primary care physician at the facility.

Pepperd explained the current staff cannot handle the workload of joining an ACO, and a nursing position would have to be created to assist with accommodating all of the patients and recording required from the District.

She explained it is going to take a team to streamline the system, and additional staff would need to be hired accordingly.

In order to account for the social detriments of health for being a member of an ACO, Pepperd explained the work flow of the clinic will have to be adjusted. She added there is a potential need for an additional office at the facility, for the nurse to meet with patients and work on recording necessary information required by the ACO.

The nursing salary is estimated to cost the District $70,000 annually, and Kragt inquired if that position could be filled in house or if the salary was adequate to attract a nurse to come to the local facility.

Pepperd explained she had an employee in mind to fill the nursing position, but if the individual fills the nursing position, it would be difficult to fill the existing role.

As CNO, Pepperd said the healthcare industry is moving towards the ACO model, and she recommended EARH needed to follow suite and join an ACO.

She did caution the commissioners to realize the ACO works together on an average, and its success is dependent on each individual hospital succeeded.

In terms of physician compare, the ACO averages the reviews, meaning a physician receiving perfect reviews locally would still be susceptible to a lower rating, dependent on the other physicians reviewed in the ACO.

Pepperd said a benefit is the addition of more billable services provided through the ACO.

Kragt made the motion to join an ACO, later adding to the motion at the request of Walker, that it was subject to approval of council.

At the time of the special meeting, the contract documents had not been reviewed by the District’s attorneys.

With Heimbigner, Walker and Kragt approving the motion, the commissioners had quorum and the motion passed.