Hospitals form an integral part of an ACO (i.e. Accountable Care Organizations), and hospitalists serve critical roles within their hospitals. Hence, they are very much interested in the impact of ACOs on their practices as ACO’s goals are a long list of hospital goals.
In a patient-centered organization, the patient and providers are true partners in care decisions, ACO is one of them. CMS has recently announced the development of a new Accountable Care Organizations model which can be named as “next-generation ACO”. To look into next-generation ACO, we need to understand the brief history of ACO.
What is ACO & its background?
Medicare ACOs are comprised of groups of doctors, hospitals, and other health care providers and suppliers who come together voluntarily to provide coordinated, high-quality care at lower costs to their Original Medicare patients.
The main objective of ACO is to ensure that the right care at the right time for beneficiaries while avoiding unnecessary duplication of services and medical error prevention, while. Moreover, Provider participation in ACOs is purely voluntary, and participating patients see no change in their Original Medicare benefits and keep their freedom to see any Medicare provider.
Since the passage of the Affordable Care Act, CMS has supervised two distinct tracks for ACOs: the Medicare Shared Savings Program and the Pioneer ACO. The Shared Savings Program is building blocks toward streamlined healthcare delivery systems while incentivizing care coordination across settings.
Pioneer ACOs, on the other hand, were designed as a test for more aggressive reforms that promised higher potential rewards in exchange for higher risk, while moving participants toward population-based payments.
Now, Next Generation ACO is based on Pioneer and Shared Savings Program Accountable Care Organizations models to test if improving care and reducing costs can be achieved using stronger financial incentives.
Next Generation Accountable Care Organizations Model
Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program (Shared Savings Program), the Next Generation Accountable Care Organizations Model offers an exciting opportunity in accountable care. Next Generation Accountable Care Organizations Model includes strong patient protections to ensure that patients have access to and receive high-quality care.
This model is specifically designed to help policymakers evaluate the impact of reimbursement and system changes with an eye toward scalability. Obtained knowledge from the next generation ACO model is helpful to design a future Medicare payment system.
Traditional ACO goals are mainly focused on reducing readmissions, maximizing efficiency, improving care transitions, and reducing the length of stay. However, the Next-generation ACO model provides the potential to capitalize on the expertise of hospitalists as the healthcare system explores ways to move away from traditional fee-for-service payments.
The model will be evaluated on its ability to deliver better care for individuals, better health for populations, and lower growth in expenditures. Moreover, the approach of this model towards paying providers is based on the quality rather than the quantity of care they provide to patients.
There is a rapid evolution in the way in which Medicare pays providers because CMS is trying hard to reimburse for the quality rather than the number of services provided to beneficiaries and this Next Generation ACO model is one tool for helping to push that goal of CMS onward.
We have a team of experts in medical billing and coding. We understand the billing regulations of all major medical specialties to help every medical practice in the ACO chain.
FAQs
1. What is an Accountable Care Organization (ACO)?
An ACO is a group of healthcare providers (doctors, hospitals, etc.) who work together to deliver coordinated, high-quality care to Medicare patients while aiming to reduce costs and avoid unnecessary services.
2. What is the difference between the Next Generation ACO and traditional ACO models?
The Next Generation ACO model builds on previous models, offering stronger financial incentives and focusing more on quality care. It aims to test if improved care and reduced costs can be achieved through these incentives.
3. How does the Next Generation ACO model benefit hospitals and hospitalists?
The Next Generation ACO model allows hospitals to improve care efficiency, reduce readmissions, and maximize care transitions. It emphasizes quality over the quantity of services, which directly benefits hospitalists by rewarding patient care outcomes.
4. Is participation in ACOs mandatory for healthcare providers?
No, participation in ACOs is voluntary for healthcare providers. Providers who join ACOs can continue to offer services to patients as usual, without changing their Original Medicare benefits.
5. How does CMS evaluate the success of the Next Generation ACO model?
CMS evaluates the Next Generation ACO model based on its ability to improve care for individuals, enhance population health, and reduce healthcare costs, while focusing on quality rather than the quantity of care provided.
