What Optometrists Need To Know About ACOs

An Informative Article Republished from AOA....

By Norma Bowyer, O.D., Greg Caldwell, O.D., Clarke Newman, O.D., Jason Ortman, O.D., David Redman, O.D., Harvey Richman, O.D., and Richard Soden, O.D.Greedy-ACO-stakeholderstable1

(EDITORS NOTE:  Euphemisms are a key to marketing many concepts  to uninformed Americans. Name it scrumptious and even horse shit can look like chocolate till you bite into it.  In this well written well researched article from the AOA,  a look at the coming ACOs and Medical Homes are given some fairly balanced thoughtful evaluation worth reading. Don't miss the stated point however, that none of these 1990's reborn capitated creations are REQUIRED to include Optometry.  Note too that from their founding it appears that the real profits are given from congressional legislators to the organizations that are at the top and the risk is totally placed at the bottom, at the doctors feet. In the past the insurance companies took the risk and like a casino earned profits.  Under ACOs doctors will now take the risk and you are not guaranteed inclusion. So who sat at the stakeholders table in designing this concept? I included a cartoon for your contemplation. Ed.)

By now, you have probably heard something about accountable care organizations (ACOs).  Some policymakers think ACOs are the most promising provision of the entire Affordable Care Act and an exciting opportunity to improve health care efficiency by improving quality and lowering costs.  Some critics and skeptics think ACOs are gatekeepers that threaten patient choice and access to optometrists.  Both views could be correct, to some extent.

In this article, the AOA dispels myths, point outs legitimate concerns, and helps you better understand the role of this new delivery model.

The managed care concept in the 1990s slowed the growth of health care spending temporarily, but the concept collapsed when patients and physicians pushed back.  Rather than control utilization to improve care, insurance companies used restrictions on utilization to enhance corporate profits.  Instead of putting profits back into the health systems to improve patient outcomes, managed care organizations didn’t reinvest.  Administrative staff, including accountants, seemed to have the last word on coverage.  But in the ACO model, savings from improved care management and coordination will be shared between practitioners and facilities, not just payers.  Medicare will determine which patients can be attributed to the ACO based on the primary care services that the patients receive, and compare their actual cost of care to the cost that would have been expected for those patients based on their health status and recent history under the traditional Medicare model.

The idea of an ACO grew out of influential research purporting to show that the cost of health care varies across the country inversely proportional to quality of care.  In other words, researchers thought that health care in some areas of the country was both high quality and low cost, while care in other areas was low quality and high cost.  Leading health policy experts believe that higher spending in parts of the country does not lead to better health care outcomes, and that overall spending on health care can be reduced while maintaining or improving quality.  By putting geographic areas in competition with each other, and rewarding top regions and improvement, all areas would be incentivized to find ways to lower costs and increase quality.  There was serious discussion of grouping all Medicare providers and suppliers into regional collaborations centered around large hospitals to compete against other regions on costs and quality.  There is also a belief that physicians – a high-achieving group – will embrace such competition and innovate.

In the Affordable Care Act, Congress declined to take a radical approach of ACOs for all.  Instead, the law opened the door for voluntary ACOs to be part of the Medicare program.  Instead of competing with other geographic regions for cost efficiency, the ACOs in the Medicare Shared Savings Program are measured against the recent history of health care costs for their own patients.  With participation voluntary instead of mandatory, the federal government implemented complicated and demanding requirements to prevent patient shopping and adverse selection.  Rather than accountants making coverage decisions in the old managed care world, lawyers became essential for the complex arrangements of previously competing, independent entities.

Read more here…….  this is a very well written article, with well respected contributors it is worth your time!


About Janr Ssor

Author, doctors, inventor of holistic eye care, programmer, community activist, network organizer, public speaker, salesman, Marketing specialist, Musician, ...lives outside the box.

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