Tuesday, November 5, 2013

Understanding Accountable Care Organizations (ACO)

Our guest blogger,  Tammy Mahan has worked in the healthcare field for over 20 years. In her free time, she shares her knowledge by writing articles for Healthline.com

The Accountable Care Organizations is primarily about doctors and healthcare facilities and their Medicare patients. It is part of the Health Care Reform and it encompasses two things:

“The healthcare reform law established the Medicare Shared Savings Program for ACOs as a key way to accomplish its two core objectives: (1) reduce healthcare costs, while (2) preserving and improving quality. Like most new legislative ideas, the ACO regs raise lots of questions.”

How Does this Affect Medicare Patients?

First, it is important to know that out of all the government funded healthcare programs, doctors, hospitals, nursing homes, and any other health care related person and facility receive the highest payment from the government for Medicare patients.

Medicare patients have to be notified if they are enrolled in an ACO and they have the right to refuse to participate in the program as well as having their medical information shared among the members in the ACO.

The goal for a Medicaid recipient in an ACO is to be provided with the best health care by their primary doctor and specialists. The ACO believes that by having the Medicaid patient in an Accountable Care Organization it will reduce the number of unnecessary tests, repeated tests and procedures, and provide better overall quality of care for the patient. It also ensures that the patients are seen in a timely manner on an inpatient and outpatient basis. It is also said to cut back on hospital admissions which of course saves thousands of dollars in patient care and prevents the patient from getting sicker in the hospital setting.

How ACO’s affects Doctors and Healthcare

Facilities Doctors and healthcare facilities must enroll in the program and agree to be a member for at least three years. In addition to caring for 5000 Medicaid patients during that time, the doctor of health care facility must agree to have no less than 75% of the ACO’s governing body.

In the event of a financial loss, the members must be willing to repay shared losses and is willing to agree to “substantial monitoring and reporting requirements, including public reporting of quality data to ensure transparency.”

Ideal Candidates for an ACO

● Doctors who work with several other doctors under one roof or are connected as one entity but spread out across rural and urban areas.
● Networks of doctors that practice different types of medicine but are all connected through a network.
● Hospitals that have doctors on staff
● Partnerships between doctors and hospitals
● Partnership between staff doctors and nursing homes Who is Not Eligible to participate in an ACO
● Nursing homes who do not staff doctors (but have one or two who come in and over-see all of the patients’ healthcare needs)
● Children’s Hospitals (most are non-profit)
● Psychiatric hospitals (Generally only have a few staff doctors and most patients are covered by Medicare or private insurance)
● Federally funded hospitals (Veterans)
● Long-term Care hospitals (usually patients are hospice and treatment is limited to comfort care)

Although this article briefly scratched the surface of Accountable Care Organizations, I hope it provided enough information so you have a better understanding of what an ACO is all about.

Want to learn more about ACOs? Join us February 10-12 in New Orleans, LA for IIR's 2014 Medicare Congress. For more information visit our website.

No comments: