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Small, rural practices face challenges when participating in alternative payment models, says GAO

The new models often require practices to take on downside financial risk, which is a lot to ask of an organization with scant resources.

Jeff Lagasse, Associate Editor

(Rhoda Baer)(Rhoda Baer)

As the Centers for Medicare and Medicaid Services has used its authority to advance value-based payment models, small and rural practices face many hurdles in participating, according to a new report from the U.S. Government Accountability Office.

For one, these practices may lack the necessary financial resources to make an initial investment in things such as electronic health records, since recouping any investments in these areas could take years. There's also staff that needs to be hired and trained, and a focus on population health is generally necessary, since patients in diverse geographic locations can make it tricky for certain practices to manage their care.

[Also: Doctors voice rising concerns for small practices under MACRA]

Small and rural practices with small patient populations may also have quality and efficiency measurement that's more susceptible to being skewed by patients that require more care, or care that's more expensive. And if those practices have fewer employees on staff, that can make it difficult to find the time needed for direct patient care, and to balance the additional administrative duties needed to ensure model participation in the new models.

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The solution could be the create partner organizations, which share financial risk, or non-partner organizations, which don't share financial risk but can provide IT and data support, though those models still present challenges.

Those new models often require practices to take on downside financial risk, which is a lot to ask of an organization with scant resources and financial reserves. Some may have to access other providers' data through interoperable EHRs, which can be beneficial but not always seamless -- an outside lab may scan test results into the system rather than type them for example, which can lead to frustration in actually accessing the data.

[Also: MACRA rules for physician payments stacked against small practices, critics say]

Risk-sharing partner organizations, depending on the nature of the arrangement, can help in a few ways. They can provide or share resources; provide education and training related to population health management; measure quality and efficiency performance; and manage compliance with the requirements of a given value-based payment model. Even the non-risk-sharing, non-partner organizations can offer services like on-the-ground technical assistance and training to improve the quality of healthcare for targeted conditions.

Still, there are a few factors that can get in the way of such partnerships, and not all of them have to do with money, although small and rural practices' limited resources certainly make matters tricky. Some accountable care organization stakeholders, for example, told the GAO they they used certain criteria to determine which physician practices to would reach out for inclusion in the ACO; one ACO stakeholder said the organization analyzes public data to identify the practices that look like good candidates for population health management, then talks to those practices about a potential partnership. So a small practice struggling to make the changes needed for good population health management may not be contacted by an organization that forms ACOs.

Twitter: @JELagasse