Accountable Care Organizations from the ACA - Research Paper Example

Fact Sheet on Accountable Care Organizations from the ACA April 04 Affordable Care Act as the suggests refers to an association which caters quality medical services to American population with the help of apt medical health care service providers .According to (Gold )“One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks which coordinate patient care and become eligible for bonuses when they deliver that care more efficiently”. The ACO can be termed as a group of providers and suppliers who cater medical service to people with a goal to deliver high quality care. The medical service providers can include hospitals, inpatient care and physicians. The ACO is a patient care organization which offers quality health care to the patients with the help of true medical care partners. ACOs stemmed from ACA As a matter of fact, many ACOs have stemmed from Affordable Care Act ( ACA) and they were of significant contribution to the US population when it came to US health care policy. Some of the ACOs which have originated from ACA can be listed as Accountable Care Coalition of Western Georgia LLC , Yavapai Accountable Care, Hartford HealthCare Affordable Care Organization, Inc and Pioneer Valley Accountable Care LLC . The formation of ACOs became an incentive to healthcare providers because it provide 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). The ACO standard and Quality Compliance It is mandatory for the ACOs to comply with certain quality standards to be approved as medical service provider and they are patient/care giver experience, prevention health , patient safety , care co-ordination and elderly care . 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). The ACO s are formulated under the ACA act with a purpose as they aim mainly at improving patient’s health care, reduce the cost of health care and improve health of the overall US population . According to (Innovalon ) “Quality performance is a key factor leading to the success of an Accountable Care Organization (ACO). Faced with the underlying mission of meeting the Triple Aim Framework in which quality improvement is the common thread unifying the goals”. We can see that ACO has a dedicated goal to serve elderly people and chronically ill patients. 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). The ACOs are highly successful and offer several programs like Medicare Shared Saving Programs, Advance Payment ACO Models and Pioneer Saving Model. According to (CMS) “When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program”. The success rate of ACO in recent times has been appreciable. The success of ACOs is visible from the mark they have made in the health care sector .According to (HHS ) “Made possible by the Affordable Care Act, ACOs encourage quality improvement and care coordination, helping to move our health care system to one that achieves the Department’s goals of better care, smarter spending, and healthier people”. 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. On the other hand, there are concerns with related to the functioning of ACOs and they are unintended financial effects, patient autonomy and physician relationships.According to (De Camp 156-161.) “From ACOs’ beginnings, the historically strained relationships between hospitals and providers were seen as a potential “cultural” barrier, and this tension continues”. When it comes to missions, concerns and direction, AMO affiliated with ACA has certain parameters. Even though the ACO has proper guidelines in context with its quality standards and missions, there is still a lurk in its direction.Their missions like low cost medical care had been a failure due to problematic performance .According to ( H&HN) “The medical shared program has been suffering inits second year and they basically failed to hit its standards. Some 80 percent of participants in the program reportedly lost money because of the high cost of operations”. On this basis, a survey conducted revealed the above statement and it is demanded that the ACO renew its regulations to achieve its targets. However, all is not well since the introduction of this 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. 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. Work Cited CMS, . "Accountable Care Organizations (ACO)." https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/aco. CMS, 2015. Web. 18 Apr. 2015. . DeCamp, Matthew. "Ethics in Accountable Care Organizations." AMA Journal of Ethics 15.2 (2015): 156-61. Print. Gold, Jenny. "FAQ On ACOs: Accountable Care Organizations, Explained." http://kaiserhealthnews.org. KFF, 2015. Web. 18 Apr. 2015. . HHS, . "Affordable Care Act initiative builds on success of ACOs." http://www.hhs.gov. HHS, 2015. Web. 18 Apr. 2015. . Innovalon, . "ACO Quality Performance: Key Success Factors." http://www.inovalon.com. Inovalon, 2015. Web. 18 Apr. 2015. Kisloff, B. "Accountable Care Organizations." Clinical Gastroenterology and Hepatology. 10.4 (2012). Print. McLean, Robert A. Financial Management in Health Care Organizations. Clifton Park, NY: Delmar Learning, 2003. 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. Stempniak, Marty. "AHA: New ACO Regulations "May be Moving in the Wrong Direction." http://www.hhnmag.com. H&HN, 2014. Web. 18 Apr. 2015.. Young, David W. Management Accounting in Health Care Organizations. San Francisco, CA: Jossey-Bass, 2003. Print. Read More