Ethics Case Study Questions And Answers

Healthcare is often driven by consumers and insurance companies; there is strong pushes for insurance companies to start paying better through Patient Care Medical Homes (PCMH) or Accountable Care Organizations (ACO) rather than paying at a per-visit basis (Hamlin, 2015). With PCMH or ACOs payment is made on a continuum of care, encouraging the provider to be involved in all aspects affecting health of the patient (Derksen, & Whelan,

An ACO are groups of healthcare providers who work together to provide cost efficient care for Medicare patients. Nurses will help an ACO by functioning as a care coordinator of Quality Improvement Manager. Care coordinators will have to manage care with doctor offices, hospitals, rehab centers, and home settings, Quality Improvement Managers will focus on analyzing data and promoting evidence based practices.

The concept of an Affordable accountable cCare oOrganization (ACO) is still evolving. Generally, an ACO is a group of health care providers (including primary care physicians, specialists, and medical facilities) that work in partnership and are collectively accountable for the cost and quality of health care they deliver to a specific population of patients. At the heart of each patient's care is a primary care physician.

The ACA included reductions in Medicare payments to plans and providers and introduced delivery system reforms that aims to improve efficiency and quality of patient care and reduce costs including accountable care organizations (ACOs), medical homes, bundled payments, and value-based purchasing initiatives”(Cubanski & Neuman, 2016, p. 2).

As the continued support grows the PCPCC, the health care sector is recognizing the role of the medical home model, Accountable Care Organizations(ACO), many entities are embracing the model and performing better. According to Center of Medicare and Medicaid, the medical home model shows that there is an improvement cost effectiveness, which helps practitioners deliver quality care and advanced approaches to care coordination, care teams, and chronic disease management. As evaluations of ACOs, integrated health systems, and the medical neighborhood continue, the Patient Center Medical Home will be essential to driving improvements in cost, quality, and outcomes. [3]

The term, Accountable-Care Organization (ACO) is a model that consists of a “group of healthcare providers, including primary care physicians, specialists, and hospitals who agree to take on a shared responsibility/partnership for the care of a defined population of patients while assuring active management of both the quality and cost of that care” (Foster, et. al, 2012). The overall goal of the ACO is to “reduce costs through preventative care and disease management, improve quality of care through multidisciplinary medical professionals, and develop the necessary skills and resources to meet the costs and quality of healthcare goals in the present and future of patient care” (Accountable Care Facts, 2012). Not to mention, patient care

The Accountable Care Organization would vastly reduce occurrence of repeat testing. This procedure reduction would create efficacy of health professional’s time and reduce unnecessary spending. In addition to the cost effectiveness of the Affordable Care Act the Accountable Care Organization creates alternatives to reducing local spending by creating an integrated network.

Accountable Care Organization (ACO) model, consist of health professional that form an affordable quality health care to those who have Medicare. These doctors, nurse and other join this team voluntarily, they contribute to this organization by hold relationship with the patient to configure the best care. The organization is designed to given the patient more “say so” into their own health/medical care. There is absolutely no catch to having the support of this organization, those are who have Medicare will remain in control over picking provider and other Medicare services. According to Niles (2018), “ACO’s is purely voluntary, and participating patients will see no change in their original Medicare benefits” (pg. 374). This service beings

Accountable Care Organizations, more commonly known as ACOs, create a new set of incentives in healthcare and drives the healthcare delivery system to change. 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. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in delivering high-quality care and spending health care dollars wisely, it shares in the savings it achieves for the Medicare program. There are several ACO programs: Medicare Shared Savings Program is a program that helps a Medicare fee-for-service program providers become an ACO; Advance Payment ACO Model is a supplementary incentive program for selected participants in the Shared Savings Program; Pioneer ACO Model is a program designed for early adopters of coordinated care.

Steve Lieberman, a consultant and senior adviser to the Health Policy Project at the Bipartisan Policy Center in Washington, D.C., explains that ACOs aim to replicate "the performance of an HMO" in holding down the cost of care while avoiding "the structural features that give the HMO control over [patient] referral patterns," which limited patient options and created a consumer backlash in the 1990s.

Accountable Care Organizations (ACOs) is defined improve health care quality and reduce health care costs by getting providers to work together and focus on the quality of care, not the quantity, the health care providers and coordinator an example possibly including doctors, hospitals, health plans and other health care constituents, Medicare payments beneficiary using the service set the organization and sharing and saving certain percent varies by payers, together to provide coordinated high quality care to populations of patients.

ACO which is accountable care organization is a group of health care professionals and facilities which help individuals get the adequate care when and if it is needed. They also connect doctors’ offices, long term facilities and short term facilities together by providing incentive for them to work together which therefore benefits the patients.

ACO is an organization that focuses on coordinated care through a group of physicians and hospitals for a defined population that directly interacts with the payers instead of going through health insurance plans (Beasley, 2015). The primary goal of ACO is to provide higher quality care while reducing the healthcare costs (Beasley, 2015). To According to Macfarlane (2014), a number of Centers for Medicare and Medicaid Services (CMS) have been promoting ACOs, due to which over the past few years the number of ACOs have expanded to more than 300 organizations. To further promote the use of ACO, CMS has even implemented a shared saving program as a promotional scheme (Beasley, 2015).

I believe that due to the fact that, the hospital is large and on the edge of technology-intensive procedures would aide in making the decision to become an ACO provider. The hospital can handle a community of 200,000 people while working with two other smaller hospitals in the area. Which brings to the table a variety of physicians and private practice to aide in assessment. The hospital main goal is to first focus on their relationship with primary care providers, as these providers determine a group’s ability to create a viable ACO group.

The next generation ACO models will allow participants to take on more risk with managing patient populations, but there will also be a greater upside potential for taking on this risk. Under this model, participants will be able to take on up to 100% risk, virtually putting these new ACOs in a fully capitated model if they choose this level of risk. The next generation ACO program includes several design features aimed at increasing adoption and success, offering greater risk and higher reward financial arrangements (Kilroy, 2016).