The Affordable Health Care Act, known as Obamacare, impacts private practices in multiple ways, but nowhere is that more evident than a pilot program of Accountable Care Organizations (ACOs).
An ACO is a group of healthcare providers that work as a team to deliver and manage patient care. Primarily aimed at Medicare patients, the goal is to prevent hospital admissions and readmissions.
It’s one of many initiatives that Obamacare is utilizing as a means of lowering healthcare costs. The outcome of the program could affect the entire way that care is delivered to seniors.
If the new method becomes the standard, it will affect any private practice that isn’t part of an ACO.
Composition And Rewards Of An ACO
The ACO is multi-disciplinary team composed of hospitals, clinicians and home care providers that are charged with providing primary and ongoing care. Services are bundled and a flat fee is paid to the team.
Bonuses will be paid when teams provide quality care that falls below a to-be-determined dollar amount.
ACOs attempt to limit costs through the reduction of “unnecessary” tests and procedures, and less usage of expensive technologies. ACOs that reach target wellness goals can keep any savings for themselves.
Home monitoring and the services of nurse practitioners, physician assistants, dietitians and care coordinators are encouraged.
At the end of three years, the information will be used to evaluate the program and discover areas where the greatest savings were found. The data will be examined by the Patient Outcomes Research Institute created by Obamacare.
The Independent Payment Advisory Board will be free to enact laws based on the Institute’s final results.
Private Practice Concerns
The financial rewards can be great for ACO participants, but if the pilot program becomes the standard, it will significantly reduce revenues for clinicians in private practice. Medicare patients will be initiated into an ACO that will handle their care from the beginning of a medical episode and for up to 30 days following discharge.
Practices that rely heavily on technology will be most affected.
It’s conceivable that private practitioners will be required to participate in an ACO or lose a significant number of patients and corresponding revenues. Some clinicians are facing pressure to sell their practices to local hospitals to become cogs in an ACO.
Practitioners will need to find alternative revenue streams that could include the sale of supplements, medical products or becoming a concierge practice.
Patient Fears For The Future
Obamacare functions on the assumption that ACOs will replace the current treatment and reimbursement model.
Many patients are concerned that the quality of their healthcare will suffer and access to technology will be limited as ACO teams prescribe treatment with an eye to a financial bonus at the end of the encounter.
The Possible End Of Employer-Based Insurance
ACOs have the potential to replace employer-based insurance. Instead of contracting with insurance carriers, employers could choose to join an ACO network to provide care for employees.
Private practices derive a significant portion of their patient base through contracts with employer-provided insurance plans.
The ACO model is an inclusive group that disperses work throughout its members. Clinicians could find their access to patients limited if they’re not ACO participants.
ACOs will affect patients and practitioners in various ways.
