What are Accountable Care Organizations?
Before we delve into the world of ACOs, it is imperative to understand a key concept, Medicare. Medicare is a U.S. government plan devised to help people aged 65 and older with their health issues. It covers people with disabilities as well as people suffering from chronic diseases and end stage renal diseases.
With that explained, let’s get on to the main topic. Accountable Care Organizations are groups of doctors, hospitals, healthcare providers and others who voluntarily work together in order to provide top quality care to Medicare patients.
A key aspect of ACOs is that they are formed to ensure that people who are suffering from chronic diseases are provided healthcare at the right time without any delays. ACOs also make sure that there are no medical errors or duplication of services provided to patients.
The ACO model derives its profit after it succeeds in providing quality healthcare and spends its budget wisely. The savings resulting from efficient budget spending are then shared amongst the entities in the ACO model.
Requirements to be part of an ACO
As per the federal laws, four types of entities can become part of an ACO.
- ACO Professionals. For example, doctors of medicine or osteopathy, physician assistants, nurse practitioners, clinical nurse specialists in group practice arrangements.
- Networks of individual practices of ACO professionals.
- Partnerships or joint venture arrangements between hospitals and ACO professionals.
- Hospitals employing ACO professionals.
In addition to these, the Proposed Rule allows the following entities to be part of ACOs.
- Providers or suppliers specified under the Social Security Act (SSA) that are otherwise not ACO professionals or hospitals.
- Critical access hospitals that bill under Method II.
Benefits of being an ACO
One of the biggest advantages of being a participant in the ACO model is that the entity will be able to capture more market share compared to those providing healthcare on the older model. In addition to this, entities in the ACO model will be able to share and manage their resources in a much more efficient way. Another important feature of being part of the ACO right now for the entities is that they will be able to survive because of the expected upcoming healthcare budget squeeze.
ACOs will revolutionize the industry in ways more than one. Since entities in the ACO will be working together, they will be able to understand each other well and will always refer a patient to someone in their own network. Its importance could be understood from the fact that although it is only a 7-page document in Obamacare, it is being debated a lot already.
Not only the entities will benefit from the ACO model, the patients will be the ultimate beneficiaries of this program. They will be subject to top quality treatment and care because of this model, will have the liberty to choose any doctor in the network and could even see a doctor outside the network without having to pay anything extra.
This model will ensure complete patient care because if ACOs do not provide that to patients, they will not be making any profit and might also stand to lose their contracts.
Cutting the long debate short, the ACO model is all set to change the fact of healthcare industry in the United States. The end beneficiary: the patients!
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