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Medicare Tracks ACOs Quality of Care

ACOs, networks of doctors and hospitals tasked with improving patient care while saving Medicare money, reported mixed rates of success in a February 2014 report that offered the first look at their effectiveness.

Voluntary creation of Accountable Care Organizations (ACOs) is the most prominent way the Affordable Care Act attempts to provide higher-quality care to Medicare recipients, including those in underserved areas, while potentially saving Medicare as much as $940 million over four years, according to the U.S. Department of Health and Human Services.

Roughly 20% of ACOs serve low-income and rural communities, and include community and rural health centers as well as critical access hospitals.  Medicare Patients

The ACOs program is designed to give financial incentives to physicians who work together to provide preventive care to maintain a patient’s health instead of Medicare’s fee-for-service method that has traditionally treated patients after they have developed health issues.

As an incentive, ACOs will be able to keep a portion of the money they save Medicare. They also agree to accept the financial risk that comes with more costly patients.

To ensure ACOs won’t cut corners in patient care in an attempt to gain the financial incentives, Medicare established 33 quality measures that must be reported to assure patient care has remained the ACOs priority.

“This year, the ACOs are getting any savings they achieve simply by reporting how their patients fared. Starting next year they have a chance to earn bonuses,” according to a Kaiser Health News article.

Among the criteria are how well the ACOs physicians coordinated care with each other, whether appropriate preventative care services were provided, whether patients suffered unnecessary harm and how patients experienced their treatment.

They also measure preventative treatment successes like how many diabetes patients avoided smoking, adhered to a daily aspirin regimen or kept their blood pressure below an established, acceptable level.

The ACOs data is reported on the Centers for Medicare and Medicaid Services website, where it will be useful to consumers who can use the site to make decisions about both physicians and healthcare facilities. Although some doubt the likelihood they will be able to effectively interpret the data.

At the time of the report, there were 250 ACOs providing care to roughly 4 million Medicare recipients. Each of the ACOs is responsible for at least 5,000 Medicare recipients, according to the Kaiser article. Patients can choose their doctors, whether they are a part of their ACOs or not. Generally, patients do not choose their ACOs.

General Medicine, The Post-Hospitalist Company, can help ACOs deliver improved care and patient health status through a patient-centered, integrated care delivery approach.

 

Tom Prose
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