Understanding ACOs and their Importance


With many industries, there is an alphabet soup of acronyms that everyone expects you to just know. In the healthcare industry, the expectation may be even greater and the acronyms even more expansive. This is where knowledge of a few of them can be of great help. One that definitely doesn’t hump out in normal conversation is ACO or Accountable Care Organization. ACOs are outlined as hospitals, clinics, other care facilities and doctors working together for Medicare patients.

Coordinating care to ensure that patients getting the right care at the right time while avoiding waste is the grand goal, and the structure by which it can be framed is the Triple Aim program. This specifies:

  • Improvement to patient care, specifically quality and satisfaction
  • Improvement to population health
  • Reduction to costs of healthcare and healthcare programs

This agenda helps healthcare facilities across the United States to be uniform and also be responsible in the same manner. It likewise allows the HHS to quantify what organizations are doing well and what needs to be improved upon.

Many expectations and mandates start within government regulatory programs, and right now healthcare is a huge proving ground for what might be coming down the pike for all healthcare facilities. Some expectations that are being tried and being worked over for implementation across the board include:

  • Risk stratification care management
  • Increasing access and patient continuity
  • Planned care for those with chronic conditions
  • Planned care for preventative treatment
  • More engagement with patients and caregivers
  • Coordination of care with different facilities and providers

To help take on the plethora of features that go along with such a large operation, a Healthcare Transformation Task Force is forming a coalition from healthcare payers and providers. When dramatic changes come down, a clear path of communication needs to be established, one where questions can be answered and where responsibilities can be assessed. It also is extremely helpful for all involved if it is one entity instead of many groups or units. The more streamlined means a more concise way of handling the bumps in the road ahead.

The overall premise behind the change and the task force comes down to basic ideals of improving the quality of healthcare and bringing costs down. These are simply stated goals but far from simple to achieve. The many facets that would go into them are far ranging and unique to each organization.

One change that will bring about both an improvement to care and reduce the costs involved is changing from a fee-for-service payment method to a pay-for-performance process. The difference is very distinct in that the current fee-for-service approach is there is a payment charged for each service provided, such as a visit to the doctors, tests or any procedure. The payments are also seen as individual and paid separately. This is quite inefficient and requires more time and effort than needs to be applied.

A move towards pay-for-performance would take into account services surrounding a patient and a situation, but also the satisfaction of the patient. The real incentive for care providers is that if they meet or exceed quality measures, financial bonuses are attached.

There are some that aren’t convinced that change is necessary or warranted because the current system is working and the proposals don’t have enough evidence to show that they would improve the healthcare system or ACOs. Some individuals believe that some sort of hybrid system might be helpful and flexibility would be a better approach. A specific concern is that those organizations that don’t meet or exceed the new standards and practices would be called out publically and would thus lose trust and confidence of the public they serve.

No system or setup is perfect, and change is always going to rock the boat. When you’re playing in the realm of healthcare and trying to better the structure as a whole, some sacrifices and risks must be played out to see what happens. ACOs are on the frontline of making some of this come to fruition and be the testing grounds to provide some risk assessment. Taking care of healthcare is an investment in the future for each of us.

What Changes Can Be Made to Quality Reporting to Keep Quality Control Measures Accurate?

First of all, medical facilities that have yet to move to e-measures should certainly consider doing so. In April of this year, the Inpatient Prospective Payment System or IPPS made a new rule through the CMS that by 2016, when participating in the Hospital Inpatient Quality Reporting Program or HIQRP, that e-measures will be mandatory. Since e-measures are professionally audited before they are passed, this reduces the chances of making a mistake. If by chance human error did occur, the blunder could be fixed before the clinical quality measures are approved, promoting accuracy and better medical facility transparency.

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