Obamacare and Accountable Care Organizations
What is an Accountable Care Organization?
Chances are you probably haven't even heard the term Accountable Care Organization but chances are equally good that you have used one. If you or a family member has utilized the healthcare system over the last year then you have probably used an Accountable Care Organization.
The Affordable Care Act, also known as "Obamacare", became law in 2010 with the goal of curtailing the cost of the United States enormous healthcare system. The centerpiece and most visible part of the Affordable Care Act was insurance reform in an attempt to provide affordable and accessible health care insurance for all Americans.
Another major goal in reforming the country's health care system is to move away from the old fee-for-service system and move toward one based on overall outcomes and cost containment.
That is where Accountable Care Organizations come into play. Accountable Care Organizations (or ACOs) are groups of providers and physicians who represent multiple levels of the health care continuum. A health care continuum consists of primary care physicians, hospitals, home health companies, and nursing facilities.
The goal of the Accountable Care Organization is to get most out of every health care dollar by rewarding the members of the ACO with a financial incentive to save the system money. If an ACO can contain cost while providing favorable outcomes, they will get a portion of the overall savings to the healthcare system.
What does that mean for you? It means your doctors and hospital social workers are taking more interest than ever in what happens to you after you leave the hospital. Sounds good but patients must remain vigilant to maintain control of their discharge plan. More on that later.
How Do Accountable Care Organizations Affect Me?
-If you have had the misfortune of spending time in the hospital recently, you probably didn't notice much difference in the day to day care that is provided. The most noticeable change for patients utilizing an Accountable Care Organization happens at discharge.
Of the all criteria used to evaluate whether a hospital stay had a successful outcome, re-admissions are considered most important. Generally speaking if a patient readmits to the Hospital with the same condition within 30 days of discharge, the system failed to provide a positive outcome.
The reasoning behind this is simple. If a patient enters the hospital with a diagnosis and readmits with the same issue the ACO either failed to provide adequate care or proper resources upon discharge from the hospital.
Because of the financial incentive involved, Hospital and Health Care providers are focused on outcomes like never before. As a result they have set up continuum's or "medical neighborhoods" to that focus on each patients unique care needs. A medical neighborhood or care continuum can consist of your Primary Care Physician, Specialists, Diagnostic Centers, Home Care, Hospice and durable medical equipment providers. These continuum's are designed to share patient information as they move from one level of care to another. The end result should be better outcomes and healthier patients.
The Downside? Patient Choice Undervalued
As with any change there is always a downside. In this case the downside is the lack of focus placed on patient choice. This lack of focus has nothing to do with the Affordable Care Act but is a bi-product of the Accountable Care System.
In an effort to control patient outcomes, Accountable Care Organizations utilize providers within their own ACO to provide care. Although patients have the right to utilize any provider they chose, could be an effort by a member of the ACO to neglect that right in hopes of controlling the outcomes. To the Hospital, it is preferable to keep the patient within the ACO so they can better control outcomes and readmission rate.
It is very important that patients and families stay involved in every health care decision. If you don't stay involved chances are a decision on which provider to utilize for aftercare could be made for you. Patients have a right to choose and be involved in healthcare decisions. Patients should excerise that right at every opportunity or run the risk of losing it.
How Do I Protect My Right To Choose?
When discharging from one level of the health care continuum to another, patients have the right to choose their providers and approve their plan of care. Even if a patient totally trusts the recommendation of the Doctor or Hospital, patients should make sure the care plan is fully explained. This will establish a culture of accountability between the patient and the provider.
Accountability is the most important factor in assuring good health care outcomes. Without accountability there is not reason to consult the patient before decisions are made. A patient or their designated advocate should communicate to their provider that consultation is mandatory before altering the patients plan of care.
Are There Accountable Care Organizations In My State?
Yes there are Accountable Care Organizations in every state. Over 406 groups have applied to become an Accoutnable Care Organization. Still others are in the process of forming groups with the intention of making an application.
Although there are many more, Becker's Hospital Review has published a list of the top 100 ACOs in the country. Click on the link to see if your neighborhood hospital is part of the list. To inquire if your neighborhood hospital is part of an Accountable Care Organization call the hospital community outreach department.
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