Advanced Payment Model to lure critical access hospitals, rural providers

Besides the highly anticipated Medicare Shared Savings Program announced yesterday, the Department of Health & Human Services (HHS) launched a complementary program, the Advanced Payment Model. To promote participation in accountable care, Medicare will provide additional support to physician-owned and rural providers enrolled in the broader Shared Savings Program. According to yesterday's HHS press release, these providers will get upfront investments so that they can implement the necessary infrastructure and health IT systems and, therefore, reap the benefits sooner.

The Advanced Payment Model only is open to physician-owned organizations, critical access hospitals, and rural providers participating in the Shared Savings Program, according to the website.

Eligible participants must be: (1) ACOs that do not include any inpatient facilities and have less than $50 million in total annual revenue; or (2) ACOs in which inpatient facilities are critical access hospitals and/or Medicare low-volume rural hospitals and have less than $80 million in total annual revenue, according to the CMS Innovations website.

Participants can receive payments in three ways: upfront fixed payments; upfront, variable payments based on the number of Medicare patients; or monthly payments varying on the size of the ACO and on the number of Medicare patients.

CMS will accept Shared Savings Program and the Advance Payment Model applications in the fall of 2011.

For more information:
- read the HHS press release
- check out the website
- check out the CMS options "menu" (.pdf)
- read the CMS Innovations webpage on the Advance Payment Model

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