Doctors, hospitals, and other health care providers who work together voluntarily to provide high quality care to Medicare patients, are being referred to as Accountable Care Organizations (ACO). These providers will be paid in untraditional ways – it is a fee for service. That means they get paid a set amount (a higher amount than they used to) and the provider accepts responsibility that for the patients they provide care, those patients will get high quality care and preventative services with the goal of decreasing acute care services for those patients. With Obamacare, a law came into effect that states the ACO providers must handle the healthcare needs for a minimum of 5,000 Medicare Beneficiaries for at least three years. |
Certain diseases have criteria defined that these providers will track. For example, a lot of patients who are overweight can lower their health issues just by losing weight. Therefore, ACO’s strive to meet this criterion for their patients:
Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside of normal parameters, a follow-up plan is documented within the past six months or during the current visit.
Normal Parameters: Age 65 years and older BMI greater than or equal to 23 and less than 30. Age 18 – 64 years BMI greater than or equal to 18.5 and less than 25.
In their EMR system, ACO track these patients as well as the criterion for five domains which are listed as patient/caregiver experience, care coordination, patient safety, preventative health, and at-risk population/frail elderly health.
How does an organization become an ACO? They must apply and if accepted they are signing up for a minimum of 3 years participation in the program. This program is monitored by CMS and they offer a couple sessions each year for new organizations that are interested in applying. They also do webinars and forums. Check out their website at http://innovation.cms.gov/Webinars-and-Forums/index.html for more information.
Another website that focuses on ACO is http://www.accountablecarefacts.org/ with tons of information on ACO and Health Care Reform as well as Case Studies. You can also search by zip code to see current ACO’s in your region if you want to speak with someone locally who has received the recognition.
You have several options (or had) when applying for ACO.
• Shared Savings Program The Shared Savings Program facilitates coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce unnecessary costs.
• Advanced Payment Model (They are currently not accepting new applicants) The Advance Payment Model is designed for physician-based and rural providers who have come together to give coordinated high quality care to the Medicare patients they serve.
• Pioneer Model (They are currently not accepting new applicants) This is for those organizations who joined the ACO as a pioneer and have years of experience as an ACO. Some people think ACO’s will harm the healthcare reform while others think it is the way to fix the rising costs of healthcare. Whatever you think, you must understand what has happened to those organizations who have been pioneers of this concept. Estimates say more than 50% of all hospitals in the US will be trying to become an ACO by 2015, which is not too far away. They just announced that 123 new organizations have been accepted into the ACO program which will help more than 1.5 million people. There has been a report in the decline of cancer patients and the costs of the healthcare provided to them in an ACO. Other studies say the administrative burdens will become too much for providers even if they believe in the concept and want to participate in becoming an ACO. Even if you do not want to be certified as an ACO, you can incorporate some of their criteria into your treatment plans for your patients and make their diseases and lives easier to manage.
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