- Accountable Care Organizations
- Accountable Care Organizations
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The healthcare industry is trying to make adjustments from the old way of doing things, which has been disjointed and non-cooperative to a well-oiled machine that has ways of sharing data when necessary. This hasn’t happened overnight, nor has it been a smooth process, however, there has been legislation set forward that helps healthcare organizations to standardize care across the board and to help improve the care patients receive. This legislation is call Accountable Care Organizations or ACO in healthcare.
Minimum Requirements to Participate
To have the label of being an Accountable Care Organization, there are a set of minimum standards that must be adhered to:
- Change from a Fee-For-Service model to a Value- or Quality-Based Payment model
- Consent to take part in the program for a minimum of 3 years
- Agree to have a legal structure established for distributing shared savings payments
- Have the leadership and management system in plays to handle all changes and issues involved
- Have enough healthcare professionals to manage the Medicare patients that will be directed to the organization
- Have in place a patient-centered criteria with the understanding of these requirements
- Define the processes being used to support evidence-based medicines and decisions
- Define how healthcare professionals will have patient engagement strategies
To help move away from the methods of the past, healthcare organizations are being asked to take on more risk, especially financially, in order to provide better care, and to control the rising cost of to care. By observing these mandates, those particular hospitals, clinics and offices can be recognized and as such be channeled patients, especially those on Medicare, to their facilities.
Quality Performance Standards
The Legislation dictates that quality and outcomes must be recorded and an improvement seen, especially in the reporting that happens with Health and Human Services (HHS) department in the government. More specifically, what HHS is looking at includes:
- Measurement of clinical and medical processes
- Measurement of outcomes
- Patient satisfaction levels
- Readmissions rates
- Use of patient-centered processes
Accounting for these and other categories helps to determine whether an organization receives a financial incentive from reimbursements for Medicare and Medicaid patients, or if they are penalized, and lose a percentage of those reimbursements. Quality performance standards tie directly into payments received, and proof of controlling costs within the healthcare system.
Reimbursement for Services
Just like most things that involve the government, there isn’t anything that is straightforward. If an organization can prove a cost savings and that they are meeting performance standards, they can receive a percentage of the amount of money they saved back. But, they must meet certain benchmarks established with the government, and they must do this on a consistent basis. If they do so, the percentage rate will increase, and the organization will receive more funds for the services provided.
However, if the organization is not able to meet benchmark standards, they could be penalized, and actually receive less for services provided. The particular reason behind this are to get organizations to take on some of the financial risk, find ways in which they can provide quality care for less, and eliminate waste within their system. The organizations that have seemed to benefit most and are showing the most improvement in these above listed characteristics are the larger and more established ones. This has been a little frustrating to smaller organizations that were already working on a razor wire line of profitability. That is why many of them have incorporated themselves with larger organizations that are better connected and have more resources to offer.
Although this solution of ACOs in healthcare is not perfect, and may go through some tweaking in the next decade or so, the premise behind it is sound and is working for the betterment of both patients and professionals. Accountability in healthcare, especially related to costs and cost control, is essential for healthcare to progress and for people to be able to afford quality care in the future. The well-oiled machine, as it were, is being developed and we are all benefiting from the results.
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