Healthcare Industry Trends

As noted by Haugen, Murugesh, Haaverstad, Eide, and Softeland (2013) wrong site surgery continues to be a problem that can be prevented through the use of a checklist. In 2008, WHO published guidelines to ensure the safety of surgical patients. The guidelines included

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).

This paper will discuss what the Accountable Care Organization is, why did Congress include it in their law, benefits and challenges for physicians and patients, and how does the ACO work for patients. We will also identify the quantitative methods in the ACO and reflect on the information provided.

In the past few years the American health care system has changed in many ways. First there was the passage of the Affordable Care Act, which is a law that is giving Americans the opportunity to obtain health care. Under this new law, in 2011, the Department of Health and Human Services decided to create Accountable Care Organizations (ACO) to help doctors, hospitals and other providers better coordinate care (AthenaHealth.com). The first idea of an Accountable Care Organization was brought up in 2006 by Elliot Fisher, MD, and now there are over 400 in the United States (Healthcatalyst.com). An ACO’s primary job is to improve health care delivery, performance, and payment. This is done through physicians and

The accountable care organization I researched is called the Physician Organization of Michigan ACO (POM ACO). The POM ACO is a joint venture of the U-M Health System and physician groups around the state, with the aim of improving care for 81,000 Michiganders enrolled in traditional Medicare and slowing the growth of health care costs, according to the announcement by the U-M Health System (Daly, 2013). The group was launched on January 1, 2013 under the Medicare Shared Savings Program. 12 physician organizations from around Michigan came together to take part in a Medicare-sponsored program that strives to improve on the quality of care for traditional Medicare recipients, while also containing cost growth. In 2014, POM ACO expanded to include all the University of Michigan faculty physicians and thousands of other providers from the University of Michigan Health System. The POM ACO is now one of the largest accountable care organizations nationwide. More than 5,700 physicians and other providers are now involved in the POM ACO. Therefore, the POM ACO is organized as a physician-hospital organization. Hence, the patient has more flexibility in where and how their care is delivered. The patient can still use any doctor or hospital that accepts Medicare at any time.

Given huge potentials and resources, the healthcare system in the United States stands among the best in the world; however, it has been constantly plagued with issues of cost, access, quality and distribution.1 The national health expenditure levels on per capita basis as well as the percentage of GDP has for several years remained higher than other OECD countries but has in contrast, been ranked low on significant health indicators.1,2 As part of the ongoing healthcare reform efforts, the Affordable Care Act (ACA) was passed in 2010 which led to outright and possible immense changes in healthcare.1 Accountable Care organizations (ACOs) were presented as the healthcare delivery system signature of the ACA, as a novel Medicare payment model.3

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)?

According to Shi and Singh an accountable care organization, also known as an ACO, describes an integrated group of providers who are willing and able to take responsibility for improving the overall health status, care efficiency, and satisfaction with care for a defined population. The ACO was established by the Patient Protection and Affordable Care Act (PPACA) Section 3022 mainly to better the quality of care to beneficiaries and to save money for Medicare (Golden). The accountable care organization is voluntary for provider participation and Medicare beneficiaries still can choose treatment from any provider they wish which is beneficial. The ACO has been viewed as a potential tool for rebuilding the traditional Medicare coverage according to Medicare Payment Advisory Commission known as MedPAC (Rosenbaum). According to CMS,

In 2008, it was estimated that “medical errors total more than $19.5 billion” (Andel, 2012, p. 12). It is important to address and solve this problem at this time because the National Quality Forums (NQF) “never events” considers such events. Never events are events that occur that should have never occurred in the first place. Reducing and eventually eliminating wrong site surgeries will help improve patient safety in the operating room and become a leading example in improving patient safety in all aspects of healthcare.

The term, Accountable-Care Organization (ACO) is a model that consists of a “group of healthcare providers, including primary care physicians, specialists, and hospitals who agree to take on a shared responsibility/partnership for the care of a defined population of patients while assuring active management of both the quality and cost of that care” (Foster, et. al, 2012). The overall goal of the ACO is to “reduce costs through preventative care and disease management, improve quality of care through multidisciplinary medical professionals, and develop the necessary skills and resources to meet the costs and quality of healthcare goals in the present and future of patient care” (Accountable Care Facts, 2012). Not to mention, patient care

The Accountable Care Organization would vastly reduce occurrence of repeat testing. This procedure reduction would create efficacy of health professional’s time and reduce unnecessary spending. In addition to the cost effectiveness of the Affordable Care Act the Accountable Care Organization creates alternatives to reducing local spending by creating an integrated network.

Accountable Care Organization (ACO) model, consist of health professional that form an affordable quality health care to those who have Medicare. These doctors, nurse and other join this team voluntarily, they contribute to this organization by hold relationship with the patient to configure the best care. The organization is designed to given the patient more “say so” into their own health/medical care. There is absolutely no catch to having the support of this organization, those are who have Medicare will remain in control over picking provider and other Medicare services. According to Niles (2018), “ACO’s is purely voluntary, and participating patients will see no change in their original Medicare benefits” (pg. 374). This service beings

At least half a million deaths per year could be prevented with effective implementation of systemic improvements in operating rooms. Specifically, multiple studies have found implementing the use of the WHO Surgical Safety Checklist would significantly reduce surgical morbidity and mortality due to surgical errors.

The overall health care industry has undergone fundamental change over the last decade. Most of the changes have occurred within the underlying business operation of the healthcare industry. Legislation in particular has had a profound impact on the health care industry. First, due to the Affordable Care Act of 2010, the nursing profession is undergoing a fundamental shift in regards to the patient experience. The U.S. health care system is now shifting the focus from acute and specialty care to that of primary care which requires a shift in business operations. Also, due primarily to that aging of the baby boomer generation, the need for primary car overall is shifting and will be needed heavily in the future. The last 10 years in particular has seen an increasing influx of retiring baby boomers that subsequently need care. A positive impact on the ACA legislation is that more individuals are now insured. As such, the need for primary care will also increase over subsequent years, particular within the minority population. This patient centric approach will require more care predicated on specific communities in a seamless manner. Furthermore, primary care physicians will be in high demand over the coming years.

Wrong site, wrong procedure, and wrong patient errors are avoidable safety issues. Nearly 1.9 trillion dollars are spent on medical errors each year in the United States (Catalano & Fickenscher, 2008). Between 1995 and 2007, 691 wrong-site surgeries have been reported to The Joint Commission's Sentinel Event data repository (AHC Media LLC, 2008). In 2003 in response to the outcry for better patient safety The Joint Commission