QUESTION: I heard that the Centers for Medicare & Medicaid Services (“CMS”) recently announced a new payment model, referred to as the “Community Health Access and Rural Transformation (“CHART”) Model.” Can you provide a brief overview of this? Is participation mandatory or voluntary?
ANSWER: CHART is a voluntary payment model intended to improve health care quality in participating rural communities. Participating rural communities have the option to choose between one of two different “tracks.” The first is labeled the Community Transformation Track, which builds upon certain lessons learned from the Maryland Total Cost of Care Model and the Pennsylvania Rural Health Model. To participate, communities must identify a Lead Organization (such as a local public health department or health system). In exchange for spearheading efforts to implement health care redesign in the targeted community, the Lead Organization is eligible to receive up to $5 million in funding. This track is scheduled to begin in July of 2021.
The second is the ACO Transformation Track. This enables rural accountable care organizations (“ACOs”) to receive advance shared savings payments. CMS hopes that these advance payments will encourage rural ACOs to advance more quickly into models that involve downside risk (i.e., two-sided risk models). This track is scheduled to begin in January of 2022.
It is important to keep in mind that the CMS Innovation Center is designed to test and experiment with various payment and service delivery models, which means that its initiatives often involve significant risk and uncertainty. CHART is no different. Although the agency hopes that this will result in improved health care quality at reduced cost, there are key obstacles that the agency (and the participants) will need to overcome. For example, what sorts of entities are well-qualified to serve as a community’s Lead Organization (responsible for developing a strategy to redesign the community’s health care delivery system)? How effective will the participants be in redesigning their health care delivery systems while simultaneously juggling the demands of the COVID-19 pandemic? Assuming that rural ACOs do choose to accept downside risk, how resilient will they be if obstacles or mistakes cause them to fall short of their goals?
If participants are able to navigate through and ultimately overcome these obstacles, it will be a promising sign for the future of large-scale efforts to promote value-based payment systems nationwide.
QUESTION: We expect to have a surge of coronavirus patients in the next week or two, so we are currently credentialing and privileging practitioners to help with the patient volume. Should we rely exclusively on disaster privileges for this, or should we consider temporary privileges instead? What about emergency privileges?
ANSWER: Emergency privileges are not an ideal tool for dealing with a pandemic. Emergency privileges are intended for scenarios where a patient experiences a sudden emergency and a physician rushes to help. For example, imagine a circumstance where a (seemingly healthy) patient is visiting your hospital and collapses suddenly. Emergency privileges would authorize a physician to provide emergency care at the scene that goes beyond the scope of his or her clinical privileges. That authorization would last only until the emergency was under control.
Consequently, the main question is whether you should grant temporary privileges (for an important patient care need) or disaster privileges. If you have a week or two to prepare for a surge in patient volume, then it may be optimal to consider temporary privileges. If you are part of a system (even if there is not a unified medical staff) you could pass a resolution allowing for the grant of temporary privileges for an important patient care need to any physician, or other practitioner, who has been fully credentialed by any hospital within the system. The only verification that would be necessary would be confirmation from the medical staff office or credentialing verification office that the individual maintains appointment and clinical privileges within the system. Additionally, as with any other grant of clinical privileges, you would have to query the NPDB. This query should be made before the physician starts to work.
Disaster privileges can be used if you need to onboard someone very quickly. Generally speaking, disaster privileges can be granted after you verify a volunteer’s identity and licensure. Accreditation standards place certain timelines on the verification of licensure. Note that the Joint Commission also requires an oversight process for volunteers who are licensed independent practitioners and who have been granted disaster privileges. Specifically, based on the oversight, the hospital must determine within 72 hours if disaster privileges should continue. A similar process must be followed for volunteers who are not licensed independent practitioners but who are “required by law and regulation to have a license, certification, or registration” (e.g., respiratory therapists).
This is a rapidly evolving topic, and it is important to consider your own unique needs and circumstances when evaluating these options.