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Study on accountable care organizations
Study on accountable care organizations
Study on accountable care organizations
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By accommodating to these changes the organization to better serve a greater population at a greater level of quality. Laws and policies also have impacted the organization, such as the Affordable Care Act (ACA). The ACA allowed more patients to have access of healthcare services, driving the demand for health care services higher. This called for the need to increase supplies and staff for the organization. With the ever-changing technology updates, the organization must keep up to date to provide the best quality of care available which can cost an organization extra time and
Medicare Shared Savings Program provides and incentive to ACO participants that are capable of lowering growth in Medicare health care costs in addition to meeting performance standards for quality of care and putting patients first. It was not until October 20, 2011 the Center for Medicaid and Medicare Services (CMS) released the final details regarding the ACO that specified the Shared Savings program authorized by ACA. The purpose of the program should improve access to capital precisely targeting those smaller ACO entities which are physician owned and/or located in rural locations. CMS will not pursue recoupment of any advanced payments not repaid from shared earnings, if the ACO completes the full three-year contract term and decides
Since CMS implemented the Physician Quality Reporting Initiative (now known as the Physician Quality Reporting System (PQRS) under the Tax Relief and Health Care Act of 2006 (TRHCA), there have been several changes in participation sanctions, reporting mechanisms and eligibility for incentives and bonuses. During the first two years, the program was technically a temporary, renewable initiative that sought to improve the quality of both delivery and coordination of care. The initiative became permanent when the Medicare Improvement for Patients and Providers Act (MIPPA, 2008) was enacted. The Centers for Medicare and Medicaid Services (CMS) believes the sanction-based initiative will empower consumers and providers to make better informed decisions
Their mission is “to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value”, (Joint Commission, 2014). The accreditation from the Joint Commission can be earned by multiple health care organizations including critical access hospitals, office based surgery centers, behavioral health care facilities, and home care services. For a hospital setting, the Joint Commission places the performance measures into accountability and non-accountability measures. They look at research and if the facility is performing evidence-based care process which improves health outcomes, proximity which the care process is linked to the patient outcomes, accuracy for whether or not the care process has indeed been provided, and any adverse effects. To earn and maintain The Joint Commission’s Gold Seal of Approval™, an organization must undergo an on-site survey by a Joint Commission survey team at least every three years (Joint Commission,
Furthermore, there should be a more reasonable distribution of cost amongst Americans, with younger and healthier Americans assuming some of the financial burden for those less healthy. Another goal of the ACA is to stabilize the skyrocketing cost of health care. One way to stabilize cost can be accomplished by reforming the way payment and reimbursement of services occurs—outcomes versus volume. A final goal of the Affordable Care Act is to provide incentives that reward wellness and preventative medicine (Panning,
ACOs as they develop may eventually evolve into total cost of care contracting. This type of payment system will pay a per member per month capitation rate and that will include all services. This would also include post acute care. This will have several effects. The first maybe that the patients no longer are discharged to SNFs , but less acute patients maybe discharged with home health care, which reduces cost.
Health Care Compliance in 2016 It's difficult to imagine that we've nearly closed the books on 2015. However, before we can really say goodbye to this year and begin focusing on what is to come in the future, we must first prepare for the changes that will take place in 2016 due to the Health Care Reform Act. While much of the ACA is already in place, there are still several portions that have yet to take effect.
A patient is going to have a different idea of how a health care should be managed. This in contrast to the way a physician may think the administration should be managed. Furthermore, each different stakeholder involved would have their own ideal reasons to why the health care administration
The Managed Care Organizations it continues the expansion of the products. The MCO business models it changes the services in mixing and volume of the patients and the representation on the multi-year contracts. It provides profiling to the current
Examples include programs to reduce unnecessary hospital readmissions by coordinating care and services for patients when they leave the hospital. Other provisions provide for the development of Accountable Care Organizations, bundled payments, and medical homes all of which are intended to provider higher-quality, coordinated care for beneficiaries. The Affordable Care Act also covers seniors on preventative services and annual wellness visits. Medicare beneficiaries are eligible to receive many preventive services with no out-of-pocket costs. These include flu shots, tobacco cessation counseling, as well as no-cost screenings for cancer, diabetes, and other chronic diseases.
Physicians and Hospitals go hand in hand when it comes to the medical care of patients, and it is this relationship that allows the patients to receive the care they need and deserve. It is also this relationship that we as health care administrators need to understand. In order to fully understand this relationship we need to define the concept of the integrated physician model. We also need to explain the importance of clinical integration in the strategic planning process, and the dynamics of and controversies surrounding accountable care organizations and alternative approaches to the current health system. I will also explain the advantages and disadvantages for hospitals and physician’s models.
In the words of Froeb, McCann, Shor, and Ward, in order to create incentives an organization must first have ways of measuring both behavior and overall performance (Froeb et. al., 2016). Thus, in order for the accountability piece to happen, a performance metric or an employee evaluation rubric is what should serve as a guide for both managers and staff. This instrument of evaluation should be utilized as a model where both the evaluator and person being evaluated collaborate to thoroughly analyze their performance and to develop a plan to either continue reinforcing the positive qualities and attributes or to devise a system for improvement. The emphasis of this evaluation model is to establish an open line of communication between managers and staff and to help gather data that can be instrumental in any management design changes that could be made in the future.
When people are doing a good job, they should be recognized that way the will continue to do their best. An incentive for proving quality based service will also be in this contract. That way instead of hospitals fighting for who see the most patients they will be competing for who is providing the best service. This initiative should equip consumers with quality of care information to make more informed decisions about their health while encouraging doctors and hospitals to improve the quality of care (Butler, 2009). Personally, think this will be ideal for the world right now.
As the healthcare landscape continues to shift, medical providers and hospitals are continuously being challenged to develop clear and concise visions and redesign care delivery in ways that will usher proper transitions to value-based care. As value-based healthcare continues to take root, more and more hospitals and providers are finding themselves with little option but to join the movement. However, the jump from previously utilized fee-for-service models to value-based healthcare is not an easy one, and many healthcare organizations are finding it difficult to do so. The greatest challenge lies in successfully making the transition from volume to value-based healthcare in ways that are financially stable. Such inherent difficulties faced by those within the healthcare system are what have necessitated strategic
The importance of accountability in the health care industry Accountability
