If you’ve been paying attention to the latest changes from the Centers of Medicare and Medicaid (CMS), you’ve likely noticed a lot of talk about ACOs, even if the meaning has been unclear. Accountable Care Organizations, or ACOs, aren’t necessarily new, but they’re important for those receiving healthcare, and certainly Medicaid and/or Medicare, in the U.S. This week, we explore the ACOs, their role and why they’re important.
CMS defines ACOs as:
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.
The purpose of the collective ACO team is to provide the best coordinated care for patients so that they’re receiving the best care without so much wasted time with duplication of services. This, naturally, will also help prevent medical errors. This is especially important for those with lifelong medical needs.
In theory, this will greatly help with healthcare budgets both the patients and the government. It is, though, a voluntary program for doctors, hospitals and other healthcare providers.
For those on Medicare, there are several ACO programs. The Medicare Shared Savings Program is designed for program providers wishing to become an ACO. This is a solution that will benefit patients both in rural and suburban areas, while the Advance Payment ACO Model was designed for selected participants in the Shared Savings Program.
There are many organizations across the nation that have already incorporated ACO models, meaning the way they deliver care has already been developed on a patient-by-patient basis. The goal is to ensure it’s a viable option so that patients have even better choices. As CMS states in its message to providers, “We want to try to meet you where you are. Our hope is to show you models of participation that will encourage you to participate in and begin this work, no matter your organization’s stage.” Remember, the better organized and functional the program is, the better it provides for its patients.
This means Medicare patients who are seeing those doctors and hospitals that are participating in an ACO will reap the benefits. That’s not to say if your current healthcare provider isn’t participating with an ACO, your service will lag or be “less than”, it simply means it’s a team effort designed to work for the needs of each patient, no matter his health requirements. In the meantime, Medicare will continue to encourage this healthcare model for service providers, including bundled payments for care improvement, community based transition programs and comprehensive primary care initiative.
It’s clear the way healthcare is being delivered is changing and while no one knows for sure the dynamics of what those efforts may look like, but ultimately, it should better protect patients so that they’re as independent and healthy as long as possible.
To learn more about Medicaid, Medicare or other elder law issues, contact The Zimmer Law Firm today.
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