When we talk about Accountable Care Organizations (ACOs) , a lot of people think that they are nothing more than a second try at the ol’ Health Maintenance Organizations (HMOs) of the late 80s. ACOs may have some things in common with HMOs, but when you look a little bit closer you’ll see that there are a few very distinct elements that differentiate them.
ACO stands for Accountable Care Organization. It is a concept that was created as a result of the Affordable Care Act (ACA). In a nutshell, an ACO is a group of doctors, hospitals, and other healthcare organizations who work together in coordinating and transforming healthcare. ACOs benefit both patients and care givers by accomplishing the triple aim: Increase Quality Reduce Cost Improve Patient Experience
The Commonwealth Fund released a report this week that revealed that the U.S. Healthcare System performs the worst- across the board – compared to other healthcare systems in the developed world.
While there are plenty of complex reasons for high rates of readmission, there are plenty that are preventable. Here are the Top 5 Mistakes made by hospitals who top this list.
As most of us are aware, readmissions is a hot topic, especially in terms of the penalties assessed for readmission rates which are excessive. What can you do to reduce or eliminate your readmission rates? There has been a lot of talk about readmissions (avoidable), specifically the healthcare costs associated with them and the effects on the quality of patient care being provided. In order to crack down on these avoidable readmissions, CMS created the Readmissions Reduction Program. The premise of the program is to ding hospitals, with higher than average readmissions (readmitted within 30 days of discharge), by assessing penalties against overall Medicare payments. There has been a lot of hoopla surrounding the program, with many criticisms being cited, such as treating all hospitals alike, not accounting for socioeconomic factors, and the way the penalty is calculated.
Overcrowding in Emergency Rooms (ERs) has been an issue of great concern as of recent years. There are a myriad of reasons why the ERs are overcrowded and ways to overcome. Let’s have a look at them. Expand Hospital Capacity By increasing the bed capacity, overcrowding can drastically go down. When there are more beds, more emergency patients can be admitted. When the population of a country grows, then obviously the number of bed capacity should be increased to avoid overcrowding. Many times, hospitals are perpetually full with admitted patients boarded inReducing overcrowding the ERs. Boarding of inpatients in the ERs is unquestionably the leading cause of overcrowding. While this seems like a simple option, there are infrastructure, costs, and the redesign of processes, to name a few, which need to occur in order to successfully add bed capacity.
Summary: Are you ready for a shift in risk from payer to provider? Will you be ready for value-based purchasing when it becomes required? Are you utilizing other reimbursement models such as bundled payments, Accountable Care Organizations, and Population Health Management? From a provider perspective, healthcare reform is aimed at tightening the purse strings, working more efficiently, reducing waste, and improving quality. The shift of risk has begun which will transform healthcare from a fee-for-service to fee-for-value. When the ultimate transformation ends, is still uncertain. As such, fee-for-service is still being utilized and providers are still generating profits and revenue based on the volume mentality while simultaneously trying to transition to a volume and quantity mentality. Juggling the opposite ends of the spectrum is no easy task.
Chances are, whether your on the administrative or clinical side of hospital operations, lowering readmission rates is high on your priority list. For administrators and financial officers, lowering the costs accrued from readmissions is paramount to staying under budget and for doctors and nurses, having patients prepared for life at home after discharge is the mark of truly community minded care. The patient-centered medical home purports medical decision making as an equal playing field; particularly when it comes to post-discharge measures of patient care.
Summary: Accountable Care Organizations (ACOs) are gaining in popularity as a result of the Affordable Care Act. Have you considered the benefits of ACOs from both the patient and provider perspectives? One of the goals of the Affordable Care Act (ACA) is to provide coordinated care which, in turn, increases quality and efficiency within the healthcare field, and reduces costs. ACOs – What is an ACO? ACOs are groups of providers which form an organization based upon the Medical Home (or PCMH) concept. The Medical Home places responsibility for the coordination of care with the primary physician. The primary care physician coordinates with other physicians and providers such as specialty physicians, laboratories and diagnostic imaging, providing a central point for the patient’s medical information.
Summary: The healthcare industry is transforming from fee-for-service to value-based payment systems. One of the fairly new forms of reimbursement to hit the streets is bundled payments. Overview of Bundled Payments The Medicare reimbursement system is in the process of transforming healthcare as we know it from a traditional fee-for-service model to a system that rewards based on quality, care coordination, accountability, and healthcare cost savings.