What is an ACO and how does it work?
Accountable care organizations, or ACOs, are groups of hospitals, physicians, and other providers who agree to coordinate care for patients and deliver the right care at the right time, while avoiding unnecessary utilization of services and medical errors.
Are ACOs good for patients?
The purpose of an accountable care organization is to provide value to patients. Instead of doctors trying to see as many patients as possible, ACOs encourage high-quality care, reduced waste, and better health outcomes for patients.
What is the benefit of joining an ACO?
ACOs take the focus away from a fee-for-service model, empowering physicians to practice individualized, patient-centered medicine. In addition to cost savings, joining an ACO can provide benefits to improve practice efficiency and morale.
Is ACO Medicare only?
Although starting as a public option under Medicare, ACOs have also grown into a force in the commercial payer market. Many ACOs have multiple contracts with payers, including Medicare and one or more private insurance companies.
What is the downside of an ACO?
Cons. Limited choice: With so many healthcare providers joining ACOs, some patients will have trouble finding doctors outside of a specific group. The shortage of options could lead to higher patient costs. Referral restrictions: ACOs provide doctors incentives to refer to specialists within the group.
What is wrong with ACOs?
After studying the conceptual and operational issues, it is concluded herein that ACOs are in the long-haul doomed for failure since: 1) most hospitals and physicians have major difficulties in consummating tightly coordinated collaborative efforts; 2) providers historically have had a dismal track record in reducing ...
Should I get an ACO?
ACOs can provide opportunities for physicians and practices to operate more efficiently and share in health care cost savings, while saving patients time, money and effort on unnecessary visits and medical procedures. But there is a significant financial risk involved for small primary care practices.
How do I opt out of Medicare ACO?
Can I opt out of having my health information shared with the ACO? Yes. If you don't want CMS to share your information with the ACO, you can contact CMS at 1-800-Medicare and ask to opt out of data sharing.
What are the four major categories for pursuing ACOs?
ACOs in the first year of performance contracts are commonly focusing on four areas: first, transforming primary care through increased access and team-based care; second, reducing avoidable emergency department use; third, strengthening practice-based care management; and fourth, developing new boundary spanner roles ...
Do patients know they are in an ACO?
Absolutely Not - if your doctor participates in an ACO, you can see any healthcare provider who accepts Medicare. Nobody - not your doctor, not your hospital - can tell you who you have to see. How do I know if my doctor is in an ACO?
What is the difference between PPO and ACO?
There are a number of important similarities and differences between ACOs, HMOs (Health Maintenance Organizations), and PPOs (Preferred Clinician Organizations): An ACO is generally based on a self-defined network of clinicians, whereas in most HMOs and PPOs, the network is defined by a health plan.
How are ACOs rewarded?
First, ACO providers are reimbursed through fee- for-service payments like most Medicare providers. ACOs are also compensated by sharing in the savings they create by improving care. If ACOs can lower spending while maintaining quality, the ACO is paid a portion of that savings.