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Opposing Viewpoints in Context?
The Theory
In this first didactic video, Thomas Cassels, Executive Director of the Advisory Board Company’s Health Care Advisory Board, summarizes the forces driving accountable care, outlines the steps necessary for a hospital or health system to transition toward operating as an accountable care organization (ACO), and provides insight into the question of whether all providers must plan to become ACOs.
The Reality
The second video is a real world look at negotiation between a hospital administrator and a PCP over setting up an Accountable Care Organization [ACO].
Video links:
- http://www.youtube.com/watch?v=53Qt7dqEjzk&feature=related
- http://www.youtube.com/watch?v=ULy5vjcGuDc&feature=youtube_gdata
Assessment
True or not?
Conclusion
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Filed under: "Doctors Only", Career Development, Point-Counter Point, Practice Management, Videos | Tagged: Accountable Care Organization, Advisory Board Company, Setting up an ACO, Thomas Cassels |
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Such a Hoot
This ME-P was a hoot – from the sublime to the ridiculous. Always some truth in jest. I loved it!
Chadwick
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CMS unveils 27 Medicare ACOs
Did you know that The Centers for Medicare & Medicaid Services just announced its long-awaited list of 27 Accountable Care Organizations (ACO) under the Medicare Shared Savings Program, as well as five Advance Payment ACOs, both beginning April 1st, 2012?
http://www.cms.gov/apps/media/press/release.asp?Counter=4333&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date
Mitchell
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More Physicians Calling the Shots in Latest Round of ACOs
Thousands of physicians will be among those coordinating patient care in the 27 accountable care organizations that were chosen in April to participate in the new Medicare shared savings payment model. The Centers for Medicare & Medicaid Services selected physician groups, hospitals, and health system organizations to be among the first networks that will share the potential rewards — and in some cases the risks — associated with coordinating quality and costs of care for beneficiaries, including at-risk populations.
The newest organizations to be chosen, which involve more than 10,000 physicians, have agreed to coordinate care for nearly 375,000 Medicare beneficiaries, the agency said during an April 10 briefing with reporters. In December 2011, 32 pioneer ACOs were selected for a similar shared savings initiative separate from the system-wide program.
Source: Charles Fiegl, AM News [4/23/12]
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What is an ACO?
Readers of this ME-P know that Health Insurance is moving away from the traditional fee-for-service (FFS) reimbursement model. In FFS, you go to a doctor who does something for you and gets paid.
If more is done the doctor may earn more.
In Massachusetts, approximately 60% of patients don’t get covered that way anymore. Now patients are put into a “global payment” system. Another older model, similar to this concept, was called medical capitation [Latin term for head]; where the doctor gets paid a fixed amount to treat a patient member/ per month [pm/pm].
A newer model is the Accountable Care Organization, or ACO. The idea in this model is for the doctor, or hospital, to get a certain amount of money from an insurance company to cover for all the care for everyone that they see. IOW: A flat rate.
If the doctor or hospital doesn’t spend it all and have lower costs; they get to keep or share the extra money. But, If they spend more than that amount with more or more expensive care, they take the hit, not the insurance company. The idea is to make the doctor or hospital put some skin in the game, so they will be incentivized to spend less on you. This is known as gain-sharing.
Of course, some say the bias here is to ration care. What do you think?
Dr. David Edward Marcinko MBA
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More ACO Insights
According to ACO Insights, ACOs are doctors, practices, hospitals and health systems forming groups for a defined geographic area’s population in the hopes of improving care and decreasing costs.
http://www.ACOInsights.com
ACOs will mark a shift in patient care and provider reimbursement. On Jan. 1, 2012, CMS, as directed by the Patient Protection and Affordable Care Act, began assigning Medicare beneficiaries to certain ACOs in each geographic area.
The theory suggests that as these ACOs provide efficient and effective care to their patient population, the savings will be shared among the components of the ACO.
We shall see; but I am a skeptic for now.
Dr. David Edward Marcinko MBA
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ACO or No?
[How to Decide]
Hospitals must weigh the benefits and perils before deciding if an accountable care organization is right for them.
http://www.trusteemag.com/display/TRU-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/TRU/Magazine/2014/Jul/fea-system-trans-accountable-care-continuum-intergration&utm_medium=email&utm_campaign=TRU
Norman
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