Controlling Costs / Improving Quality Of Care

Financial incentives play a significant role in how care is provided. The North Ohio Heart Center was found to perform more angioplasties compared to the Cleveland Clinic performing bypass surgeries resulting in different incentive rates (McLaughlin & McLaughlin, 2015). These non-invasive procedures (angioplasties) generated highly profitable incomes for the physicians involved at the North Ohio Heart Center. The physicians perceived these procedures to be a safer option of treatment as opposed to drug treatment or bypass surgery. These decisions impacted patient care by causing more patient visits and more tests being performed generating a cumulative higher reimbursement. These incentives are moving us away from what is best for the patient. Robert Doherty, ACP senior vice president, stated, “we need to move away from the piecemeal approach: how many visits you can generate, how many tests

In 2012, the ACA found an excessive amount of readmissions of patients that were hospitalized within 30 days for the same medical conditions. This factor viewed under the ACA as a quality issue and CMS implemented value-based incentive payments based on performance in a set of quality measures. The plan is to implement a pay for performance (P4P) in formulas used by Medicare to reimbursement providers. “The objective is to link reimbursement to quality and efficiency as an incentive to improve the quality of health care, as well as reduce system-wide costs” (Shi and Singh, 2015). In addition to the P4P, nonprofit hospitals also focus on continual improvement, data and cost containment throughout the organization (Adamopoulos,

The Accountable Care Organization (ACO) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients (McCarty, B., 2016). For example, Medicare Shared Savings Program was created by The Center for Medicare & Medicaid Services to monitor and establish that all ACO’s are meeting the quality performance benchmarks and reduce Medicare spending by certain percentages (H., 2017). The growth of ACO’s from 2011 to 2016 is astonishing, in 2011 there was 64 ACO’s and by 2016 they have risen to 838 in the U.S. (H., 2017).

However, many healthcare groups disapproved of the proposal as costly due to the partial incentives offered by the program. Correia, E (2011) stated the Affordable Care Act and regulations of the formation of ACOs provide a creative form of reimbursement that is intentional to motivate providers within the ACO to reduce costs while maintaining quality. This ensures hospital administrators and physician groups are supposed to provide the best care while ensuring the patients remains healthy in their care.

The concept of an Affordable accountable cCare oOrganization (ACO) is still evolving. Generally, an ACO is a group of health care providers (including primary care physicians, specialists, and medical facilities) that work in partnership and are collectively accountable for the cost and quality of health care they deliver to a specific population of patients. At the heart of each patient's care is a primary care physician.

ACOs provide high-quality care to their patients and reduce cost by avoiding unnecessary duplication of services and preventing medical errors. ACOs may involve a variety of provider configurations, it can range from integrated delivery systems and primary care medical groups to hospital-based systems and virtual networks of physicians such as independent practice associations (McClellan et al, 2010).

Throughout history there have been many acts and guidelines created to try and improve quality of care. MACRA falls into this category of an act that tries to enhance the quality of care for patients under Medicare. Harry A. Sultz and Kristina M. Young, the authors of Health Care USA Understanding Its Organization and Delivery, write that quality was defined as “the degree of conformity with preset standards.” (p. 140) The new definition of quality that Harry A. Sultz and Kristina M. Young write characterizes the quality of a provider’s care as the degree to which the care delivered increases the likelihood of desired patient outcomes and reduces the likelihood of undesired outcomes. (p. 144-145) MACRA was signed into law to try and lead to better patient outcomes by paying physicians based on whether their services are successful or not. The new definition focuses on increasing desired patient outcomes and reducing undesired patient outcomes, and this relates to MACRA because MACRA tries to improve patient outcomes and tries to promote more successful treatments. Another relevant, but more specific course concept would be the Accountable Care Organization (ACO) model. Harry A. Sultz and Kristina M. Young write that the ACO payment structure shifts the orientation of patient care from a series of fee-for-service reimbursed interventions toward financial reward for maintaining patients’ health. (p.

The Affordable Care Act (ACA) legislated in 2010, has changed the United States health care industry. In addition to universal healthcare, one of the principles of the ACA is the ideal of accountable care. Specifically, adopting an Accountable Care organization (ACO) for Medicare beneficiaries under the fee for service program. An ACO seeks to hold providers and health organizations accountable for not only the quality of health care they provide to a population, but also keeping the cost of care down (1). This is accomplished by offering financial incentives to the healthcare providers that cooperate in, circumventing avoidable tests and procedures. The ACO model, seeks to remove present obstacles to refining the value of care, including a payment system that rewards the volume and intensity of provided services instead of quality and cost performance and commonly held assumptions that more medical care is equivalent to higher quality care (2) .A successful ACO model, will have developed quality clinical work and continual improvement while effectively managing costs, however this is contingent upon its ability to encourage hospitals, physicians, post-acute care facilities, and other providers involved to form connections that aid in coordination of care delivery throughout different settings and groups, and evaluate data on costs and outcomes(3). This establishes the ACO will need to have organizational aptitude to institute an administrative body to manage patient care,

As you are well aware of, how patient care is delivered is ever-changing in the healthcare world in which we live in. Since the passing of the Affordable Care Act or “Obamacare” in March of 2010 the world of healthcare that we know has drastically changed. In 2011 the U.S. Department of Health and Human Services (HHS) developed new rules under “Obamacare”, aimed at helping doctors, hospitals and other provider’s better coordinate care by implementing Accountable Care Organizations, or ACOs Leavitt Partners has been actively tracking ACOs since 2010 and the number of current ACO’s in the United States as of January 2015 is 744. According to the Leavitt Partners survey, over 23.5 million people are being covered under one of the ACO models (Health Affairs Blog, 2015). According to these statistics and growing number of hospitals participating in ACOs, where is does your hospitals potential financial performance stand if it were to become part of an Accountable Care Organization (ACO)?

Even although, the cost of the health care system and the care it offers my not allow the national debt to decline to a level that will or would enhance the economy forward the cost of running a system that is backed by the government is too costly, and it will not help the deficit. , the legal responsibility of the organization is that every patron should have the same treatment for the same ailment. There are no predetermined dispositions; everyone is eligible as a government-backed facility. The funds are to assure those who have no insurance are covered. The accountable care

Huber (2014) explains the ACOs receive a definitive payment for each enrolled patient and disperses it among those who provided care for each patient. ACOs receive incentives for reducing costs and delivering quality care and are penalized when not delivered (Gold, 2011). While patients may choose not to participate if their PCP is in an ACO, there are benefits if they choose to stay (Gold, 2011). First, their care would be coordinated properly, efficiently, and would have a seamless continuity of care. Secondly, all providers would have central access to their health information (Huber, 2014).

In addition, Dr. Bekanich explained the rational of ACO is to ensure that patients get the care that they need, at the right time, to avoid unnecessary or duplicative tests or procedures; and to experience better health outcomes.

The American health care system has been victim to an escalation in the prices of health care services juxtaposed with inefficiency in delivery of care services. There has even been cases where State spending on the actual health care increased dramatically in the United States and one of the key components of curbing this problem which has been prevalent over the mass media and has been a major discussion among physicians is the advent of Accountable Care Organizations. Accountable Care Organizations (ACOs) is structured with the goal of trying to improve health care delivery and aid in the reduction of the overall cost of services (Weissert & Weissert, 2012). If there is insufficient coordination of high quality care delivery in the health care industry, this will have a negative impact on patient safety and diminish affordable care for patients. Hence, the development of ACOs is envisioned to be the savior of medical practices and can improve the overall fabric of the American society (Bresnick, 2013). ACOs serves as one of the answers for curbing the problem of high costs, low quality care and possible segmented delivery and as much as it serve as the major determinant for improvement in patient satisfaction, there are minor

“An ounce of prevention is worth a pound of cure”. That is how Patient centered medical care thinks. Their focus is to keep patients healthy, and not only treat them when they are sick. An accountable care organization (ACO) is a healthcare organization interested in measuring the quality of care and cost reduction when dealing with a specific group of patients. Was started in 2006. http://en.wikipedia.org/wiki/Accountable_care_organization

The positive outcomes that have resulted due to value base programs have caused the model to gain traction and ignite one of the largest changes in history in the health care marketplace. By linking reimbursements to service quality, insurers such as the Centers for Medicare and Medicaid Services have facilitated a massive leap forward in the performance of United States health care providers. This achievement is a considerable accomplishment in the face of an institution that has received reimbursement from insurers via a fee-for-service model during the last 75 years. Soon, valued based payment models will represent the norm as more insurers support initiatives such as shared savings program, integrated clinical care, and accountable care payment models.