The Role of Allergists in Accountable Care Organizations - Research Paper Example

The Role of Allergists in Accountable Care Organizations The adoption of more accountable healthcare system seems inevitable especially with the very comprehensive value based reimbursement of this new replacement of the old free for service program. Some leading providers within the organization are sometimes however divided on what right response should be. Accountable care organizations have been a move lauded by many as the only replacement for earlier free for pay. Some provider’s organization has reviewed extensively with the experts in healthcare sector the viability of this program and they gave a go ahead note. This experts and other that have researched on the program gave their insights by addressing hospitals, doctors and individuals seeking for the services and their insights help provider organizations construct a common culture that supports the creation of value for everyone (Robert 58).  Accountable care organizations were developed by center for Medicare and Medicaid which is an agency within the department of health and human service to help hospitals, doctors and other health care providers coordinate well when it come to providing care for Medicare patients. This formation was part of the final regulations under the affordable care act. The formation of ACOs became an incentive to healthcare providers because it provides a platform where they can coordinate the administration of care to the individual patients across these different healthcare structures and between doctors and hospitals (Nissenson, Maddux, Velez, Mayne, and Parks 725). ACOs are rewarded by the Medicare shared saving program if they put patients first and provide standard service top individual patients at a lower cost. To participate in ACOs is voluntary for those healthcare providers interested in this kind of arrangements. Center for Medicare and Medicaid service in coming up with the policies to regulate the program Ensured that all stakeholders in the healthcare sector were involved. All the federal government agencies were closely involved so as to ensure that there was inter and intra agency contribution towards the implementation of this shared saving program (Nissenson, Maddux, Velez, Mayne, and Parks 725). Center for Medicare and Medicaid service ensured that it encouraged all the healthcare providers to review these program regulations and to subsequently make an effort to join it. The process of participation in the shared saving program is easy all providers who want to join just come together to become Medicare ACO, and ACO must apply to center for Medicare and Medicaid service ACO that has been in existence will not be obviously registered into the program. Center for Medicare and Medicaid service will accept ACOs that are eligible and meet all the requirements and those that have at least 5000 free for service patients and agree to remain in the program for at least 3 years (Anderson 1368). These participants in the shared saving plan as ACO will be receiving payments under Medicare free for service rules. Affordable care act require ACOs to set up a body to represent ACO service providers, beneficiaries of Medicaid and Medicare and suppliers. ACO has a very huge role including responsibility to set up a process to ensure that there is quality evidence-based medicine, make patient engagement interesting to patients (Kreindler, Larson, Wu, Carluzzo, Gbemudu, Struthers, Citters , Shortell, Nelson, and Fisher 459). It is also ACOs duty to ensure that care is well coordinated and that there is internal report on cost and quality. The new program regulations is similar to the current Medicare free for service payments whereby the Medicare is paying for suppliers and this healthcare service providers for the service and items they provide to the patients under free for service payments system. However ACOs don’t just receive shared saving but it has to be vetted by CMS using the benchmark standard they have develop, this standard will ensure that only the best service provider is allowed to offer this program (Kisloff 103). ACOs also accept responsibilities and are ready to be held accountable for loses in the course of service delivery. The modality for determining who to give service among ACOs is the cost that the patient in free for service will incur in comparison to eh amount it will have incurred in the absence of ACO. The cost should be lower in order for the benefit of ACO to be felt across and to attract more service providers to join in. The benchmark also consider the characteristic and other critical issues that are capable of affecting the health care service. This Benchmark is updated for each performance year within the agreement period. 106 new ACOs in Medicare have currently ensured that close to 4 million individuals under free for service scheme have access to standard care that is well coordinated care across United States. Since the introduction of this program expenditure has been increasing by small margin with an increase by just 0.4% in 2012. Growth in Medicare spending has hit historic low currently (McLean 172). Though there are a lot of critics on the program it is still too early to gauge the effectiveness of accountable care organizations but no one can stand and claim that the program is off and running. They have made a significant gateway in very short period of time and many magazines recently have been offering insights hailing the impact and contribution and significant improvement the program brought to the health sector (DiFiore 623). There are over 300 ACOs today operating in 48 states signifying a rapid pace that the programs have taken. The models developed are to ensure that there is effective coordinated care and improve the individual’s health. No one has been sure whether the models will be able to lower cost within a short time (Young 82). All is not well however since the introduction of the program. Some accountable care organization have dropped out of the program since joining including three that were set to check on the payment system and the delivery model, this polite program was carried with a small group of standard providers believed to be best prepared to handle the operational demands and financial risks. The three organizations were Genesys PHO, Franciscan Alliance, and Renaissance Health Network. References Cimasi, Robert J. Accountable Care Organizations: Value Metrics and Capital Formation. Boca Raton: CRC Press, 2013. Internet resource Young, David W. Management Accounting in Health Care Organizations. San Francisco, CA: Jossey-Bass, 2003. Print. McLean, Robert A. Financial Management in Health Care Organizations. Clifton Park, NY: Delmar Learning, 2003. Print. Kisloff, B. "Accountable Care Organizations." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association. 10.4 (2012). Print. "Implementing the Affordable Care Act: What Role for Accountable Care Organizations?" Seton Hall Law Review. 42.4 (2012). Print. Anderson, Gerard F. "Leadership in Creating Accountable Care Organizations." Journal of General Internal Medicine. 26.11 (2011): 1368-1370. Print. Kreindler, SA, BK Larson, FM Wu, KL Carluzzo, JN Gbemudu, A Struthers, Citters A. D. VAN, SM Shortell, EC Nelson, and ES Fisher. "Interpretations of Integration in Early Accountable Care Organizations." The Milbank Quarterly. 90.3 (2012): 457-83. Print. Kisloff, B. "Accountable Care Organizations." Clinical Gastroenterology and Hepatology. 10.4 (2012). Print. Nissenson, AR, FW Maddux, RL Velez, TJ Mayne, and J Parks. "Accountable Care Organizations and Esrd: the Time Has Come." American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation. 59.5 (2012): 724-33. Print. Shulkin, DJ. "The Role of Allergists in Accountable Care Organizations." Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology. 111.6 (2013): 437-8. Print. DiFiore, M. "Accountable Care Organizations: What You Need to Know." Journal of the American College of Radiology: Jacr. 11.6 (2014): 623-4. Print. Pauly, MV. "Accountable Care Organizations and Kidney Disease Care: Health Reform Innovation or More Same-Old, Same-Old?" American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation. 60.4 (2012): 524-9. Print. Bard, Marc, and Michael Nugent. Accountable Care Organizations: Your Guide to Design, Strategy, and Implementation. Chicago, Ill: Health Administration Press, 2011. Print. Flareau, Bruce, Joanne Bohn, and Colin Konschak. Accountable Care Organizations: A Roadmap for Success, Guidance on First Steps. Virginia Beach: Convurgent, 2011. Print. Ruggiero, Jeffrey R, Mark Shields, and Patricia Donovan. Blueprint for Aco Success: Clinical, Quality and Compliance Considerations for an Accountable Care Organization. , 2011. Print. Read More