In this paper you are going to learn all about the Accountable Care Organization (ACO). Also, how does it pertain to the healthcare system? We will also be learning about the reimbursement rates for Medicare patients. Who makes up the Accountable Care Organization? We will also take a look into the Affordable Care Act and how the ACO is a part of that. 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 …show more content…
They have the ability to manage patients across for continued care and that includes acute, ambulatory, and post acute health services. 2. The capability for them to plan the budgets and determine what resources are needed. 3. ACOs want the appropriate size to support comprehensive, valid, and reliable measurement of performance. “These analysts proposed an “extended hospital medical staff” to reduce fragmentation and to increase coordination, thereby improving the quality of care and curbing its cost” (Casto, Forrestal, & American Health Information Management Association, 2013, p. 283). The government is hoping by improving the quality of care it will in turn slow the rise of health care …show more content…
113). From my understanding of this program, this works with private payers by having provider incentives that will improve the quality and health for patients across the ACO. Which in turn will be a cost saving for Medicare, patients, and employers. They payment model was being tested in the first two years it came out and the results were very interesting. So basically for the first two years there was a shared savings payment policy for higher levels of savings and the risk for the Pioneer ACOs than the current Medicare Shared Savings Program. When it came to year three, the participating ACOs that had seen a specific level of savings the past two years, will be eligible to have a substantial portion of their payments to a population based model. So you may want to know why providers choose to be a part of an
Cimasi, R. J. (2013). Accountable care organizations: Value metrics and capital formation. (pp. 90-92). CRC Press. Retrieved from http://books.google.com/books?id=EDMTlDWYvmUC&dq=specific service payment bundled&source=gbs_navlinks_s
The challenges that all acute care hospitals and facilities faces are the demand for highly specialized services has increased. The US population is constantly aging and the elderly tend to need more acute care services. Because many people lack health insurance, they tend to use emergency rooms in the hospitals as their source of care. The increase demand in acute care prompted hospitals to expand their facility
... to ensure that it meets their individual organizational needs, be it acute care, hospice care, general practice or even subspecialty care.
It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds.
In December 2011, Texas Health and Human Services Commission (HHSC) received federal approval of a Medicaid Section 1115(a) Demonstration Waiver, entitled “Texas Healthcare Transformation and Quality Improvement Program,” for the period starting with December 12, 2011 through September 20, 2016. The main objective of the 1115 Waiver is to improve access to and quality of health care by expanding Medicaid managed care programs and promoting health care delivery system reforms while containing cost growth. Specifically, the Waiver created two new pools of funding—Uncompensated Care (UC) and Delivery System Redesign and Innovation Payment (DSRIP) pools—by redirecting funds that were available under the old Upper Payment Limit (UPL) payment methodology. DSRIP funding is used to offer financial incentives to health care providers that develop and implement projects aimed at improving how care is delivered to low-income populations. Specifically, the providers (often referred to as the “performing providers” or “performers”) propose and execute projects like programs, strategies, and investments designed to enhance access to health care, quality of health care, cost-effectiveness of services, and health of the patients and families served.
Healthcare in the U.S. has recently been affected by implementation of the Affordable Care Act (ACA) of 2010. The intent is to create a healthca...
With these types of organizations they have different methods of payments and reimbursements. They have guidelines through the government that they will have to abide by. The government sponsored payers are Medicaid and Medicare. The majority of patients that are treated are on Medicare or Medicaid. With patients not insured each type of organization handles reimbursement differently. For- Profit hospitals it is bad debt, which is when charges of patient are written off. With not –for –profit organizations it is considered charity care. This type of care has to be documented and reported on tax status.
Conclusion: All of these initiatives, and also the affordable Care Act as a whole, work toward one overarching goal: creating and keeping folks healthier by providing top quality, cost-efficient services that everybody can access. New models to deliver care - as well as provider groups, nurse-led community health centers, patient-centered medical homes, and responsible Care Organizations. a number of the providers who don't agree with the approach the ACA takes and are vocal regarding the issues within the system and also the ways in which to fix it therefore it will benefit both patients and providers. regardless of wherever we stand on this issue, the present state of affairs of healthcare, both in delivery of services and the way we pay for them, isn't sustainable.
The United States (U.S.) has a health care system that is much different than any other health care system in the world (Nies & McEwen, 2015). It is frequently recognized as one with most recent technological inventions, but at the same time is often criticized for being overly expensive (Nies & McEwen, 2015). In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) (U. S. Department of Health & Human Services, n.d.) This plan was implemented in an attempt to make preventative care more affordable and accessible for all uninsured Americans (U.S. Department of Health & Human Services, n.d.). Under the law, the new Patient’s Bill of Rights gives consumers the power to be in charge of their health care choices. (U.S. Department of Health & Human Services, n.d.).
Ingram, R., Scutchfield, F. D., & Costich, J. F. (2015). Government, law, and public health practice: Public Health Departments and Accountable Care Organizations: Finding common ground in Population Health. American Journal of Public Health, 105(5), 840-846 7p. doi:10.2105/AJPH.2014.302483
The current health care reimbursement system in the United State is not cost effective, and politicians, along with insurance companies, are searching for a new reimbursement model. A new health care arrangement, value based health care, seems to be gaining momentum with help from the biggest piece of health care legislation within the last decade; the Affordable Care Act is pushing the health care system to adopt this arrangement. However, the community of health care providers is attempting to slow the momentum of the value based health care, because they wish to maintain their autonomy under the current fee-for-service reimbursement system (FFS).
Organizational capabilities refer to an organization 's skill in combining its resources to produce goods and services. These capabilities are organized in a chain of activities that gives the product or service more added values. Since the patients are hopping from Caring Angle Hospital to other specialized hospitals looking for various treatment of care (Burns, Bradley, & Weiner, 2012). For instance, heart and cardiovascular care would be two great specialized cares for our facility and for the larger community. To add to that value, Caring Angel Hospital will need to enhance the scope of those physicians who specialize in the treatment of heart and cardiovascular care.
The Affordable Care Act, more commonly known as Obamacare, is a new health policy created by the American federal government. Its purpose is to make healthcare more affordable and friendly for the people. Unfortunately in some way that does not prove to be the case. It is becoming apparent that Obama may have made some misleading statements to help get the ACA put into action. The ACA is sprinkled with many flaws that call for a reform such as people’s current plans being terminated, high costs, and at minimum some people’s hours being cut by their employers.
Health insurance, too many American citizens, is not an option. However, some citizens find it unnecessary. Working in the health care field, I witness the effects of uninsured patients on medical offices. Too often, I see a “self-pay” patient receive care from their doctor and then fail to pay for it. Altogether, their refusal to pay leaves the office at a loss of money and calls for patients to pay extra in covering for the cost of the care the uninsured patient received. One office visit does not seem like too big of an expense, but multiple patients failing to pay for the care they receive adds up. Imagine the hospital bills that patients fail to pay; health services in a hospital are double, sometimes triple, in price at a hospital. It is unfair that paying patients are responsible for covering these unpaid services. Luckily, the Affordable Care Act was passed on March 23, 2010, otherwise known as Obamacare. Obamacare is necessary in America because it calls for all citizens to be health insured, no worrying about pre-existing conditions, and free benefits for men and women’s health.
...staff would not be required to put in the overtime to compensate for the lack of workers. Patients would no longer have to suffer the neglect of the staff because he or she was too busy. Making sure the patient gets the best quality care reduces the time spent for recovery. Reducing the time spent for recovery increases the organization’s finances. Providing a safe facility also reduces the expenses on the private hospital’s budget. Ensuring a patient is safe can reduce potential use of ongoing treatment and services. Hiring the appropriate nursing staff needed can save the organization money. Instead of cutting back on staff, more staff needs to be hired to fulfil the needs of the patient. In the economy today, private hospitals need to focus on the overall long term effects of each action opposed to quick reactions resulting in financial strain for the facility.