Response/Reflection #2
Student Response #1
Accountable Care Organizations are both a business venture and a health care delivery system. If you improve quality, finances will follow suit. Financial incentives are provided to provide higher quality care by keeping patients healthier in Accountable Care Organizations. The Accountable Care Organization programs were put into place to raise the quality of care and reduce waste in the health care system. It entices health care facilities and physicians to work collaboratively to focus on the patient population ensuring that care is given when needed. Several programs are in place that provide financial incentive to Accountable Care Organizations. The first, the Medicare Shared Savings Program is based on patient care experiences and cost reduction. The second program, the Advanced Payment Model provides funds to invest in their infrastructure to make it easier to coordinate care. These funds are eventually paid back as the institution benefits from the cost savings. The third program is the Pioneer ACO model that is for early adopters. These facilities already had a system in place that allowed a collaborative culture, giving them the ability to transition to the population-based payment model quicker (Panning, 2014). Accountable Care Organizations are partially dependent on the experiences reported by patients for their funding.
Eliminating testing and procedures that do not prove to be beneficial to patient care is one step in this accountability reform. This is a major change in practices for providers in the United States. The traditional fee-for-service payment system in the United States provided financial incentives for more testing and procedures (Callaghan, Burke, Kerber, & Skolarus, 2016). Providing care for patients at a fee-per-patient is a different approach giving incentives to limit testing and procedures that are not helpful in achieving a diagnosis. Over use of expensive procedures and testing has been one of the contributing factors to this incentive. Unfortunately reliance in these technologies has caused medicine to be practiced differently and clinical judgement can be compromised as a result.
Test utilization management is a way laboratories can participate in this. I have been a Medical Technologist for 18 years and have seen a dramatic change in practices over the years. New testing has allowed us to get a quicker diagnosis in many cases. Inappropriate testing often leads to confusion in diagnosis, which is why I am involved in testing consultation on a regular basis. Medical Laboratory Scientists are utilized to interpret testing and provide testing limitations to aide in diagnosis. Laboratory tests are a major tool provider’s use, but they are useful when used properly. This is one reason the culture of laboratory medicine is changing into a consultative culture.
Chronic conditions are the main target of these programs due to their drain on the finances of health care institutions. I witness every day repeat testing on patients to address a symptom of a bigger issue. Urine cultures are an excellent example of over utilization. Literature suggests that urine cultures have limited capability of detecting urinary tract infections and often underlying issues exist in patients with chronic urinary tract infections. Rather than referring patients to urologists, antibiotics are administered and the problem temporarily disappears. In many cases, this cycle continues for years. A lack of communication between providers and patients appears to perpetuate the issue. The communication is only one of many issues our health care system faces. The proposal of the Accountable Care Organizations is one opportunity to address these chronic issues by providing financial incentive to improve care. Only time will tell if it is effective.
References
Callaghan, B. C., Burke, J. F., Kerber, K. A., & Skolarus, L. E. (2016). The changing US health-
care landscape: Opportunities and challenges. The Lancet Neurology, 15(4), 351-352. doi:http://dx.doi.org.proxy.davenport.edu/10.1016/S1474-4422(16)00064-8
McWilliams, J. M., Landon, B. E., Chernew, M. E., & Zaslavsky, A. M. (2014). Changes in
patients' experiences in medicare accountable care organizations. The New England Journal of Medicine, 371(18), 1715-24. Retrieved fromhttp://search.proquest.com.proxy.davenport.edu/docview/1618918352?accountid=40195
Panning, R. (2014). Accountable care organizations: An integrated model of patient care
objectives. Clinical Laboratory Science, 27(2), 112-8. Retrieved fromhttp://search.proquest.com.proxy.davenport.edu/docview/1530677910?accountid=40195
Student Response #2
Healthcare system in United States has various providers but common ones or Preferred provided organization (PPO) or Health maintenance organization (HMO). Accountable care organization (ACO) that works with payments with quality of care, it based on the capitation where set amount was paid to healthcare professionals like physicians for set time period regardless of patients obtained ant treatment or no treatment. It can be easily misused and can be a business, especially if there is shortage of physicians in town. For example, “While ACOs are touted as a way to help fix an inefficient payment system that rewards more, not better, care, some economists warn they could lead to greater consolidation in the health care industry, which could allow some providers to charge more if they’re the only game in town”(Gold 2015). Additionally, ACO can also be looked at the cost reduction for hospitals by having good outpatients clinics and ambulatory services, which reduces the amount of patients seen in hospital, which later can shrink in size which is beneficial as business aspects in healthcare system. For example, “Hospital inpatient services continues decline. Executives see Ambulatory Care as an essential, no longer a supplemental service line. Hospital survival can depend heavily on Ambulatory Care”(Shi 2015). It proves how hospitals are trying to cut down their expenses by using alternatives methods to provide healthcare for patients. However the quality of care would be questionable if these situations persist.
Another prospect of view of ACO would be providing healthcare for everyone who is eligible by Medicaid, ACO policy would be more lean towards service than as a business of the policy was based on person and their existing condition. Their premium might be high, however the once patients have reached limit for out pocket, state and federal funds would be used in form of Medicaid. For example, “Currently, Medicaid costs are shared between states and the federal government, but the funding is open-ended, so the federal government pays its percentage of whatever states spend. Under the proposed bill, the amount of federal funding would be capped on a per-person basis, so funding would go up as more people qualify”(Rovner 2017). Since Medicaid is paid mostly by federal funds and State funds not by the person, physicians can spend time with patients to provide best care regardless of time spend by the physicians with patients certain amount is paid for physicians for patients visits and treatment. Additionally, having this system could benefit many lower income patients to obtain the good care even with the preexisting condition; additionally some of the prescribed drugs are also covered in this policy with minimum or no payment from out of pocket. It also benefits many patients who cannot afford to take prescribed medication at least on emergency purposes, for example “The new payment package also includes coverage for some prescription drugs to treat the emergency condition that brought the observation patient to the hospital, said Debby Rogers, the California Hospital Association’s vice president of clinical performance and transformation”(Jaffe 2017). This prospect of ACO shows this policy primary intention to provide the good care and services regardless of the money from patient or from Medicaid.
Considering these factors ACO policy could be beneficial or business venture depends on how healthcare organization prioritizes. Even if the healthcare organization uses to ensure as beneficial act for providing good service for the community, there could be always a possible chance that healthcare professional can misuse and make it as business for making more profits by increasing the quantity of patients seen than quality of care. ACO policy can be beneficial under very strict rules and regulations from policy makers to healthcare administrators, even having small details missing in the policy can be misused by the healthcare professional and can become a business venture rather than service for people.
Reference
Gold. J. (2015, September 14). Accountable care organizations, Explained. Retrieved March 14, 2017,http://khn.org/news/aco-accountable-care-organization-faq/?gclid=Cj0KEQiA5IHEBRCLr_PZvq2_6qcBEiQAL4cQ06MnwcKRzPwDXE0VEq5GVgS-4KggBHrZddwT9r0WdugaAi9-8P8HAQ
Jaffe. S. (2017, March 13). By law, Hospitals now must tell Medicare patients when care is observation only. Retrieved March 14, 2017, http://khn.org/news/by-law-hospitals-now-must-tell-medicare-patients-when-care-is-observation-only/
Rovner. J. (2017, March 8). Five ways the GOP health bill would reverse course from the ACA. Retrieved March 14, 2017,http://khn.org/news/five-ways-the-gop-health-bill-would-reverse-course-from-the-aca/
Shi. L. (2015). Delivering Healthcare in America in systematic approach. 6th ed Retrieved March 14, 2017,https://docs.google.com/presentation/d/1uUFd6_qloo7BafWYz7iAsQfGP8O4we149X0ZES4ToWw/edit#slide=id.p4
Student Response #3
The concept of accountable care organizations in The United States was first introduced by the affordable care act or Obamacare. An accountable care organization also referred to as an ACO is the government's attempt to develop healthcare networks made up of doctors and hospitals who collaborate with one another. This system offers cost savings to providers in healthcare by attempting to keep their patients healthy. “The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors” (CMS, 2016). One of the stipulations for an accountable care organization under the affordable care act is that at minimum networks must consist of 5,000 medicare recipients over the course of three years. The primary reason that this idea was introduced was seen as a way to control medicare costs, that will continue to rise over the foreseeable future as baby boomers age.
Accountable care organizations have faced some criticisms for a number of reasons. The main concern is from a consumer perspective. If hospitals and physician networks continue to partner with one another and merger, there will be less alternatives for patients. When an accountable care organization becomes too big, it can have a majority of the market share, meaning it will have too much market power. This means a very large accountable care organization will be able to increase prices, leaving patients with no other option but to receive care at a higher price. Some people within the accountable care organizations networks are also concerned about the profitability of such a system. However, “according to an August 2015 report of ACO’s from CMS the 20 accountable care organizations in the Pioneer ACO Model and 333 Medicare Shared Shavings Program ACOs generated more than $411 million in total savings in 2014, which includes all ACOs’ savings and losses” (Obamacare Facts, 2016). Some ACOs did lose money but it is important to note that as an accountable care organization continues to operate the programs will tend to increase in performance and profitable over time.
Accountable Care Organizations have become a hot topic in recent years but they are the product of decades of refinement. During the 1970s HMOs started working on assigning accountability to their systems. Then in the 90s providers started forming networks of providers, called IDSs, with a goal of improving citizens health, improving quality of care and minimizing costs. However, this program struggled and led to the failure of multiple businesses. During the turn of the century, the center for medicaid and medicare floated the idea of a collaboration between hospitals and groups of physicians. This ultimately lead to the development and implementation of accountable care organizations. “In an attempt to realize the threefold expectations of cost, quality and population health, ACOs use mechanisms already prevalent in managed care and IDSs-disease management, care coordination, sharing of cost savings with providers, use of information technology” (Shi & Singh, 2015, p. 312).
References
CMS. (2016). Accountable Care Organizations (ACO). Retrieved March 15, 2017,
from CMS website: https://www.cms.gov/Medicare/
Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/aco
Obamacare Facts. (2016). ACOs (Accountable Care Organizations). Retrieved March
15, 2017, from Obamacare Facts website: http://obamacarefacts.com/
aco-accountable-care-organizations/
Shi, L., & Singh, D. (2015). Delivering Health Care in America A Systems
Approach (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Student Response #4
According to Overview (2015) “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.” The primary goal of the Accountable Care Organizations is to guarantee that chronically ill patients receive the appropriate care at the appropriate time (Overview, 2015). The hopes is that these precaution will prevent care duplications and medical errors while also ensuring their profits, from preventing wasteful medical care, is shared with Medicare programs (Overview, 2015). Health providers must voluntarily choose to participate in such programs, no health care provider is ever forced into working under an Accountable Care Organization and fee-of-service Medicare holders who decide to support ACOs are allowed to do so without any penalties or fees (Overview, 2015).
The Accountable Care Organizations allows for doctors to care for their patients in a preventative way, by preventing diseases and illnesses they decrease the amount spent on each patient which creates a higher revenue. Having sick patients cost more money in the long term than does having healthy patients. This preventative healthcare system encourages healthier patients and lowers net loss per patient. Accountable Care Organizations create a population healthcare management which allows them to “Create a care delivery network which can service a population of patients in a defensible area by assembling the appropriate provider resources (primary care physicians, specialists, hospitals, etc.). Clinically defining the populations of patients for which the organization is willing and able to assume risk. Systematically improving the quality of the care being delivered to those populations and ensuring the appropriate amount of care is delivered. Systematically eliminating waste within the care delivery process, thus reducing the cost per member per month” according to What is an ACO (2017).
This healthcare system takes into account that every patient is different and their needs are also different, it eliminates clumping patients together due to their illnesses and allows physicians to create an individualized preventative care system for each patient. Just because a patient has high blood pressure does not mean that they need blood pressure medication. By preventing high blood pressure, the physician is preventing cardiovascular disease and renal disease, to name a few, which lowers the cost per patient. Accountable Care Organizations allow for provider-led organizations, which allows for the primary physician to be responsible for the quality and capita costs of that patients care (McClellan, McKethan, Lewis, Roski, Fisher, 2010). It also allows for the payments to physicians to be based n the quality improvements and reduced costs for their patients and allows for the proper support for said physicians in overall health care improvements (McClellan, McKethan, Lewis, Roski, Fisher, 2010).
References:
Overview. (2015, January 06). Retrieved March 15, 2017, from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=%2Faco
What is an ACO? Definitive Guide: Accountable Care Organizations. (2017, March 09). Retrieved March 15, 2017, from https://www.healthcatalyst.com/what-is-an-ACO-definitive-guide-accountable-care-organizations
McClellan M, McKethan AN, Lewis JL, Roski J, Fisher ES (2010). "A National Strategy to Put Accountable Care Into Practice". Health Aff (Millwood). 29 (5): 982–90. doi:10.1377/hlthaff.2010.0194. PMID 20439895.
Student Response #5
According to Shi and Singh (2015), an accountable care organization (ACO) is “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” (p. 367). Per Shi and Singh (2015), the concept of accountability in health care has been around since the 1970s when it was originally linked with health maintenance organizations (HMOs). Following the reign of HMOs, integrated delivery systems (IDS) took over in the 1990s as a healthcare delivery system focused on provider accountability, while also attempting to improve the quality of care and control costs. Today, ACOs are a reiteration of some aspects of care first introduced through HMOs and IDSs.
The accountable care organization approach to care comes courtesy of the Affordable Care Act, though, as mentioned above, the concept is not entirely new. In fact, many people believe that ACOs are simply health maintenance organizations by another name. While this is true is some regards, ACOs and HMOs actually differ several ways, which will be discussed later. First, let’s discuss ACOs as a healthcare delivery system. Similar to Shi and Singh’s definition of an ACO, Jenny Gold (2015) writes that “an ACO is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending” (para. 5).
Essentially, an accountable care organization’s goal is to improve healthcare quality and outcomes, while reducing costs, by eliminating waste. The thought behind this concept is that currently, healthcare providers are too isolated from one another. In today’s healthcare landscape patients see their primary care physician, surgeons, specialists, hospitalists, etc. However, more often than not, those medical professionals are not in contact with one another. This can lead to several problems, including: repeated medical tests, duplicate prescriptions, conflicting prescriptions, conflicting diagnoses/advice, etc. All of these issues are a waste of time, resources, and money for the patient, providers, and the healthcare industry. ACOs, which “can include hospitals, specialists, post-acute providers and even private companies like Walgreens”, seek to coordinate patient care, so that patients receive a higher quality of care at a reduced cost (Gold, 2015, para. 18). ACOs are focused around each patient’s primary care physician, and aim to connect all of the different components of the patient’s care, so that they work together. Obviously, the proper implementation of this concept would lead to many benefits for patients, but providers benefit as well. “ACOs make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and save money by avoiding unnecessary tests and procedures…Those that save money while also meeting quality targets keep a portion of the savings” (Gold, 2015, para. 10).
As mentioned above, ACOs share several similarities with HMOs. That is because the ACO model is based on the HMO model. However, there are some differences. There are two key differences according to Gold (2015): First, unlike HMOs, ACOs give patients more options, as they are not required to stay in network. Second, ACOs must not only cut costs, but they must also meet quality standards, to ensure that they aren’t also cutting corners when it comes to patient care.
References
Gold, J. (2015, September 14). Accountable care organizations, explained. Kaiser Health News.Retrieved from http://khn.org/news/aco-accountable-care-organization-faq/?gclid=Cj0KEQiA5IHEBRCLr_PZvq2_6qcBEiQAL4cQ06MnwcKRzPwDXE0VEq5GVgS-4KggBHrZddwT9r0WdugaAi9-8P8HAQ
Shi, L., and Singh, D. (2015). Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Student Response #6
Recently there have been many changes made to U.S. healthcare system. Medicare offers several Accountable Care Organization (ACO) program, which will help deliver care across the country. “The Accountable Care Organizations (ACO) are groups of doctors, hospitals, and other health care providers, who come together to give coordinated high quality care to their Medicare patients” (ACO, 2015). The main goal of ACO program is to ensure that patients get right care at the right time by avoiding unnecessary test and procedures, which will eventually prevent medical errors. The current U.S. healthcare delivery system deliver services that are cost-effective and meet standard quality of care. The healthcare delivery system goal is to increase access to healthcare and make it more affordable everyone, so all U.S. citizens and legal residents can have health insurance.
However; ACO is a business venture and not a healthcare delivery system. The reason being that it takes a carrot-and-stick approach by encouraging to add ACO as one of the Medicare program. This basically means if the provider keeps their patients healthy then they are going to make more money. “About 6 million Medicare beneficiaries are now in an ACO, and combined with private sector, at least 744 organizations have become ACO since 2011. An estimated 23.5 million Americans are now being served by an ACO” (Gold, 2016). Why ACO has become sudden drive of interest in healthcare? It is because when Medicare offers ACO, doctors and hospitals are paid directly for each test and procedures, which can increase the cost and in return providers are rewarded by doing more. ACO basically create an incentive for providers by offering bonuses when providers keep their cost down and maintain good health for their patients. This basically sounds like a trading business. Having providers to keep their cost down and perform each test and procedure, then reward them back with bonuses when they keep their patient healthy. When providers meet specific benchmarks on preventive care on managing chronic disease, which will keeping their patients healthy and out of the hospital will get more paid then providers who do not meet the specific benchmark. Overall, ACO goal is to have providers take full financial responsibility for their patients by offering them rewards and bonuses in return.
According to CMS.Gov, Medicare offers several ACO programs, which include Medicare Shared Savings Program, Advance Payment ACO model, and Pioneer ACO model. Medicare Shared Savings program helps Medicare fee-for-service program providers to become an ACO. Advance Payment ACO model is “a supplementary incentive programs for selected participants in the Shared Savings Program” (ACO, 2015). Pioneer ACO model is designed for coordinated care. Out of these three, ACO is based on Advance Payment ACO model. With the Advance Payment ACO model, “selected participants will receive upfront and monthly payments, which they can use to make important investment in their care coordination infrastructure” (ACO model 2017). This means that the providers will receives upfront money, which will be a fixed payment. So all the providers will have knowledge of how much money they are getting to keep their patients healthy in advance, which will decrease chances of medical errors. In conclusion, the Advance Payment ACO model is to help providers and hospitals to keep their patients healthy and out of hospital and also to avoid unnecessary test and procedures.
Reference:
Accountable Care Organizations (ACO). (2015, January 06). Retrieved March 15, 2017, from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=%2Faco
Advance Payment ACO Model. (n.d.). Retrieved March 15, 2017, from https://innovation.cms.gov/initiatives/Advance-Payment-ACO-Model/
Gold, J. (2016, July 13). Accountable Care Organizations, Explained. Retrieved March 15, 2017, from http://khn.org/news/aco-accountable-care-organization-faq/?gclid=Cj0KEQiA5IHEBRCLr_PZvq2_6qcBEiQAL4cQ06MnwcKRzPwDXE0VEq5GVgS-4KggBHrZddwT9r0WdugaAi9-8P8HAQ
Student Response #7
In order to explain whether Accountable Care Organization (ACO) is a healthcare delivery system or a business venture, we must first define and examine (ACO) in order to fully understand what ACO does and how it conducts its business. ACO is a type of organization that partnership between hospitals and physicians to coordinate and deliver efficient care (McCarty, 2016). Under ACO, physicians are agreed to be accountable for the quality, cost and overall care of Medicare beneficiaries who are enrolled in the traditional fee for service program who are assigned to it under ACO. These healthcare providers share not only financial and medical responsibility but also for providing coordinated care to patients in hope of limiting unnecessary spending. One of the qualification to participate in ACO network under Affordable Care Act(ACA), each ACO has to manage the healthcare needs of a minimum of 5000 Medicare beneficiaries for at least three years which means most of these physicians have a great deal of understanding how Medicare works (Gold, 2011). one of the biggest advantage of the ACO in that it brings together a different component parts of care for patient such as primary car, specialists, hospitals, home health care, etc. and ensures that all of the components are working well for the patients.
The way ACO accounts are set up is very interesting because it creates and provides an incentive for the physicians to be more efficient by offering bonuses when healthcare providers keep costs down unlike the traditional Medicare’s fee for service payment system where physicians and hospitals generally are paid for each test and procedure which drives up costs and doing more tests and procedures when it’s not necessary. This approach allows physicians to focus on more prevention and managing patients with chronic illnesses and in turn, physicians earn more for keeping their patients healthy and out of the hospital. Additionally, Physicians and hospitals most likely will refer patients to hospitals and specialists within the same ACO network which makes easier to share information about their patients among each other however patients have the right to notify their physicians regards to opting out on sharing their information with other ACO network physicians.
Finally, many types of ACO models have been introduced by the centers for Medicare & Medicaid services (CMS) and by commercial payers such as, Medicare Shared Savings Program, Advance Payment ACO Model and Pioneer ACO Model and all of the models are eligible to receive bonuses based on shared savings and outcomes. Regardless which models are used the ultimate goals of each models are to work together in a new way to lower costs, improve population health, and better patient outcomes. It is imperative for each parts of ACO communicate effectively with all of the partnering organizations and work together in order to be successful. The above models also provide development tools to help with beneficiary engagement, such as greater access to post discharge home visits, telehealth services, and skilled nursing facilities to continue for better outcome for patients and to build rapport with other physicians within the same network.
Reference
McCarty, B. (2011). ACOs – Pros, Cons & Challenges of Accountable Care. Retrieved on March 15, 2017 from https://eligible.com/community/pros-cons-accountable-care-acos/
Gold, J, (2011). Accountable Care Organizations, Explained. Retrieved on March 15, 2017 from http://www.npr.org/2011/04/01/132937232/accountable-care-organizations-explained
