The Impact Of Affordable Care Organizations

The change to value based purchasing has bought many challenges to the healthcare industry. With the change to value-based purchasing for payments, it has changed how healthcare organization receive payment and delivery care. The advantage of have value based purchasing is that it improves the quality of care while reducing cost in an effort of aligning patient’s with the right provider and treatment plan (Minemyer, Jun 29, 2016). However, there are many disadvantages, such as it increases the patient volume as counteracting the reduction of procedure volume (Brown, B. & Crapo, 2016). Also it makes providers more responsible for care that is beyond the expected treatment of care needed (Minemyer, Jun 29, 2016). With quality measures tied

Since the late 1980s, Medicare has reimbursed physician services using the Medicare Physician Fee Schedule (MPFS), which encompasses 10,000 procedure codes. Each code is assigned resource-based relative value units (RVUs), which are designed to reflect physician work, practice expense, and malpractice expense. To adjust for local differences in cost of living, each RVU is modified using geographic practice cost indexes (GPCIs) and then converted to dollars using a “conversion factor.” This system rewards physicians who produce a high volume of services; not surprisingly, Medicare Part B expenditures have grown rapidly.

Healthcare is often driven by consumers and insurance companies; there is strong pushes for insurance companies to start paying better through Patient Care Medical Homes (PCMH) or Accountable Care Organizations (ACO) rather than paying at a per-visit basis (Hamlin, 2015). With PCMH or ACOs payment is made on a continuum of care, encouraging the provider to be involved in all aspects affecting health of the patient (Derksen, & Whelan,

The Patient Protection and Affordable Care Act (ACA) is the 2010 health reform act that could extend insurance coverage to as many as 32 million Americans, which also included policies that affect the quality of coverage insurers must offer (Knickman & Kovner, 2015). In addition to this, the ACA created a range of programs focused on furthering change in how medical care is organized and delivered, with a goal of reducing costs and improving quality and outcomes (Knickman & Kovner, 2015). However, these goals come at a cost. The purpose of this paper is to analyze the impact the ACA had on the population it affected in the United States as a nation, but specifically in the state of North Carolina; describe the impact of economics of providing care to patients from the organization’s point of view; examine how patients were affected by the ACA in terms of the cost, quality, and access to treatment; and explain the ethical implications of the ACA.

ACO, another 3 letter health care organization consisting of integrated groups of providers, comes along promising the elusive goal of reducing health care cost, improving population health, and bolstering custom satisfaction. Sounds like a perpetual remake of a 70s movie called HMO that went through several reiterations over the past decades which gave us PPO, PSO, IDS, and the different flavors of MCOs. ACO’s hype is credited to the Affordable Care Act as it sought to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently. Bottom line, providers are promised to make more if they

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.

When Medicare was first established, Medicare adopted the payment methods of Blue Cross Blue Shield which meant that the program was paid hospitals on the basis of their own costs and physicians were being reimbursed by the fees that they charged which caused hospitals and physicians to provide care without boundaries (Anderson et al., 2015). This method caused Medicare to dissipate the budget that was established for beneficiaries to utilize. Now, with the ACA being implemented, Medicare had done an overhaul of payment reimbursement. Medicare is now moving toward a volume to value payment initiative that links payment to patient outcomes, experience of care, while giving providers an incentive to limit spending

In reviewing the article you referenced, “Affordable Care Act Initiative Builds on Success of ACO’s”, one could recognize that the Centers for Medicare & Medicare Services (CMS) has identified issues with their original plan for Accountable Care Organizations (ACO). As you have stated, they have decided introduce a newer version called “The Next Generation ACO Model” (HHS, 2015). This “next-gen” model aims to “create greater coordination and close care relationships between ACO providers and beneficiaries” (HHS, 2015).

Historically, reimbursement has been Fee-For-Service (FFS): tied to volume of visits, hospitalizations, procedures, and tests. This reimbursement structure creates misaligned incentives and fragmented, suboptimal patient care resulting in burgeoning costs and a lack of focus on outcomes. As a result, CMS and the industry have been

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

The Patient Protection and Affordable Care Act (ACA) of 2010, was instrumental in the revamping of the health care delivery and insurance coverage systems in the United States. Within the many guidelines set forth by ACA, there are two models of health care delivery that have flourished by this health care reform. Medical Homes and Accountable care organizations (ACOs) provide patients with comprehensive care. Although both models are similar in nature, they differ in their approach to health care, assistance provided to and incentives received for patients, and the way services are delivered from the traditional models of the past.

The Accountable Care Act (ACO): Is one of the model care delivery, which is a ‘shared saving’ with Medicare (Part A, & B). The ACO is a teamwork that exists among physicians, hospitals specialists and other health care workers who welcomes mutual responsibility for the quality and cost of care rendered to patients. (American Nurses Association, 2010, p.2). The PPACA law allows ho in the ACO profession can lead the other, thereby allowing them to take part in leadership. For their success, the law targets the value that relieves heavily on the services of the nursing care, thereby allowing more avenues for the nurses to participate. (ANA, 2010). The ACO model improves the quality of healthcare, improves patient

The Affordable Care Act (ACA) has developed the plan to move from fee for service to fee for quality. To improve quality of care, federal reimbursement programs have been initiated. For example, Centers for Medicaid and Medicare Services (CMS) set up the Value Based Purchasing program. This program has four domains: Clinical care, patient experience, safety and efficiency (CMS, 2016). Each domain has reimbursement ties; this ensures hospitals are doing their best to provide quality care. Another reimbursement model is insurance companies paying for performance. Insurance companies look at high cost procedures or conditions and create patient registries that collect data. This data is then used in determining best

Payments models will continue to change in 2016 and in order to get paid what they deserve, physicians will have to prepare to take on more risk. When Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in April, providers across the country breathed a sigh of relief. It wasn’t long, however, until doctors realized that solution came with a price: incentives to move away from the old fee-for-service payment model toward quality-of-care models for Medicare payments.

14). Considering the emphasis by the Accountable Care Act (ACA) on managed care, this study is relevant to the health care system of today. Using claims data of the 52 practices being studied, “273,000 enrollees” were reviewed for cost of services (Kralewski et al., 2013, p. 14). An average payment for procedures and drugs were determined for all participating facilities and this average was used to analyze overall costs. Furthermore, specific quality metrics were identified including diabetes, cervical cancer screening and high blood pressure. Finally, readmission and emergency room visit rates were included in the study.