Current Payment Model Ffs Payment

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Introduction An Accountable Care Organization or ACO is a group of doctors, hospitals, and healthcare providers, who voluntarily come together and provide coordinated high quality medical care to Medicare patients. Coordinated care is generally intended to guarantee that patients (especially the chronically ill) get the appropriate care at the right time, avoid service duplication and averting medical errors, in the process. In PPACA or Obamacare, each ACO manages the health care needs of at least 5,000 Medicare beneficiaries for around three years. ACOs are representative of a significant shift from a health care system focused on payment to largely rewards volume, rather than value, of services. When an ACO succeeds, both in delivering…show more content…
This program is currently not accepting applications. ● Organizations throughout the country have already updated their care delivery methods to match those of the ACOs that Medicare supports. Within the MSSP there are two “tracks” for ACOs to choose between depending on the amount of risk the ACOs wish to undertake. These two tracks increase the likelihood that more ACOs will choose to affiliate with Medicare by offering a range of financial risk that can be incurred by the ACOs. Track 1 permit ACOs to obtain 50% of the savings if said ACOs are under the budget that has been established by Centers for Medicare & Medicaid Services (CMS). Additionally, these Track 1 ACOs are not monetarily penalized if their organization goes over the CMS budget. The second track is referred to as the Pioneer ACO model that is geared towards providers who are willing to accept more financial risk in the form of monetary penalties if their ACO goes over the budget provided by CMS. In return for accepting this risk, those Pioneer ACOs are able to acquire 60% of the shared savings . Table 1: Accountable Care Organizations Utilizing Different Payment Plans Capitation Bundled Payments Track 1 Shared Savings Track 2 Shared Savings Pay-for-Performance Variants Hospital System (n=28) 17.9% 14.3% 35.7% 64.3% 32.1% Physician Group (n-10) 40.0% 0% 40.0% 40.0% 40.0% Overall (n=38) 23.7% 10.5% 57.9% 57.9% 34.2% Table directly based on data from
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