Accountable Care Organizations (ACOs) are groups of healthcare professionals and facilities that work within a network to deliver services and coordinate care for Medicare patients. They attempt to deliver the best care that stays within a specified “pre-paid” dollar amount.
ACOs accomplish that goal through eliminating duplication of services, utilizing in-home care when appropriate, reducing the use of costly tests, and eliminating long-term hospital stays.
When an ACO succeeds in its goals, every member of the team shares in the savings achieved for the Medicare program through a bonus system.
Participating in an ACO is voluntary, but in an Obamacare economy, many clinicians are faced with a loss of revenues if they don’t become part of an ACO network.
ACOs were designed as a means of providing better care instead of more care to patients.
Providers are paid more if they keep their patients well.
Many practitioners are concerned about the financial viability of their practice should they choose not to participate in an ACO.
The federal government has money to fund ACO startups and incentive programs to assist providers and facilities that want to participate.
Meaningful use incentives can be accessed and programs specifically developed for rural areas can receive money up front to develop and implement a Medicare Shared Savings Program to cover costs ranging from staff to infrastructure.
Continuing operation costs would be financed through Medicare and Medicaid, along with insurance premiums from patients and/or employers.
To provide the level of care expected of ACO members, each individual and facility must be able to communicate seamlessly and electronically with each other.
The fear for clinicians and many patients is that a lower level of care will become standard as providers try to retain a greater part of the money saved by not ordering tests that are deemed as too expensive.
The current trend is to utilize preventative tests and screenings to prevent health problems before they occur, but it leaves many who already have health concerns wondering what direction their healthcare will take.