The Rural Care Organizations Improvement Act Of 2015

The Patient Protection and Affordable Care Act (ACA) has created new forms of care organizations in order to provide better healthcare to Medicare and Medicaid patients at a greater value. The two types of organizations that this paper will focus on are Accountable Care Organizations (ACO’s) and Coordinated Care Organizations (CCO’s). There has been much information gathered regarding the similarities and differences between these organizations. This research has been conducted to better understand the way that ACO’s and CCO’s effect the hospitals, physicians, insurance providers, and patients involved in their implementation.

The ACA includes four initiatives designed to provide increasingly patient centered care. Primary care nurses could see job locations or job descriptions changes with the implementation of these initiatives. These initiatives include Accountable Care Organizations (ACO), Medical Health Home (MHH), Community Health Centers (CHC), and Nurse Managed Health Centers (NMHC).

H.R. 6261promotes the utilization of not only primary care services provided by Accountable Care Organizations (ACO’s) physicians, but also those provided by other ACO such as nurse practitioners, to increase patient access to quality care while reducing costs in underserved areas.

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).

The Affordable Care Act created a new approach to care which is called the Accountable Care Organization. ACO is a system of doctors and hospitals that share a financial and medical responsibilities. If the ACO is successful in meeting quality and cost savings targets, these organizations qualify for financial incentives or shared saving from Medicare programs. The goal of the ACO is to coordinate

The Medicare Shared Savings Program was established by section 3022 of the Affordable Care Act and aims to improve beneficiary outcomes and increase the value of care by providing better care for individuals, better health for populations, and lowering growth in expenditures (Lieberman, & Bertko, 2011). The Affordable Care Act created ACOs, which is part of Medicare since January 2012, together with a Shared Savings Program it has the potential to lower costs, improve the quality of care, facilitate delivery system reform, and promote innovation in health care ( Lieberman, & Bertko, 2011).

With the passing of the Affordable Care Act in 2010 approximately 32 million more people will be insured throughout the United States. The need for healthcare workers and providers will be in drastic demand to provide care to these insured Americans. The 2010 IOM report details out how the advanced practice nurse can be a valuable asset in primary, chronic and transitional care and their skill set should be used to promote better healthcare across the nation (IOM, 2010). This impact of this report should help progress advanced practice nurse’s ability to practice without individual state regulation and be governed under one body to server in and outside of the hospital setting

​Kaiser Health News recently published an article on a new trend in healthcare. This trend introduces the Accountable Care Organization (ACO). The Centers for Medicare and Medicaid services defines it as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients” (“Accountable Care Organization,” 2015). According to the Affordable Care Act (ACA), the goal of the ACO is to be able to share health cost-savings with providers who are able to save money by eliminating unnecessary procedures and reduce health costs while increasing quality of care. ACOs make health professionals become more accountable in maintaining good-quality, coordinated healthcare for a patient through a value-based system that is evaluated through a number of criteria and benchmarks (Ronai, 2011).

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,

The ACA included reductions in Medicare payments to plans and providers and introduced delivery system reforms that aims to improve efficiency and quality of patient care and reduce costs including accountable care organizations (ACOs), medical homes, bundled payments, and value-based purchasing initiatives”(Cubanski & Neuman, 2016, p. 2).

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

What is the Accountable Care Organization? “Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients” (www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html). The ACO is a component of the Affordable Care Act (ACA). “The Patient Protection and Affordable Care Act (PPACA) – also known as the Affordable Care Act or ACA, and generally referred to as Obamacare – is the landmark health reform legislation passed by the 111th Congress and signed into law by President Barack Obama in March 2010” (www.healthinsurance.org). One of the main reasons the ACO mainly focuses on Medicare patients because due to the aging, their health problems will become chronic disease and that will have an impact on the healthcare cost years to come. It is stated that about 78% of the total health care is spent for chronic diseases.

The federal law that would be waived by the specific waiver on which the ACO (accountable care organization) and its participants intend to rely is “The Beneficiary Inducements CMP Law” and the waiver is the Waiver for Patient Incentives. This law prohibits offering or giving something of value to Medicare or Medicaid patients that would influence their choice of provider (from text book pg-184). The ACO’s formed in connection to the Shared Savings program, helps beneficiaries to obtain incentives offered to encourage preventive care and comply with the treatment regime. In the absence of the patient incentive waiver, the ACO is influencing the beneficiaries to accept the services from a specific provider thus, violating the Beneficiary Inducements CMP Law.

The ACA establishes the Shared Savings Program in a new section 1899 of the Social Security Act. ACA § 3022 (codified at 42 U.S.C. § 1395jjj). The purpose of the program is to bend the health sector cost curve, and to facilitate coordination and cooperation between providers to improve quality for fee-for-service Medicare beneficiaries. Eligible providers can (but are not mandated) to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (“ACO”).

Rural Americans face an exclusive combination of issues that create disparities in health care that are not found in urban areas. Many complications met by healthcare providers and patients in rural arears are massively different than those located in urban areas. Financial factors, cultural and social variances, educational deficiencies, lack of acknowledgement by delegates and the absolute isolation of living in remote rural areas all combined to hinder rural Americans in their struggle to lead a normal, healthy life. Rural hospitals located in rural areas faces many disadvantages, such as; minimum resources, shortcoming or unprepared professionals, and financial disparities. Although many of these challenges could be solved