Medicare ACOs


 

As a result of the Affordable Care Act, the creation of Accountable Care Organizations (ACO) took place for fee-for-service Medicare members to receive coordinated care from a group of health care professionals. ACOs are formed by various physicians, hospitals and facilities to work as a unit to provide care to Medicare patients under one roof. Due to the high number of chronically ill Medicare recipients, it is encouraged by these groups to treat conditions and illnesses promptly and efficiently, steering clear of unnecessary, repetitive treatment or medical errors.

These organizations were created in order to save money for the Medicare program and also ensure the delivery of high quality health care services when necessary. Patients are served with personal attention from a team of experienced health care providers, treated in such a way that reduces preventable hospitalizations and offers more support and resources for the patient in many cases under one roof in a “medical home.”

How ACOs Work

Accountable care organizations are groups of health care providers that agree to be accountable for the quality, cost, and overall care of Medicare recipients who are enrolled in the traditional fee-for-service program who are assigned to it. They are led by the participating doctors and hospitals, and use a primary care physician to facilitate and oversee how patients are treated. These groups are jointly responsible for the overall quality and entire costs of all care continuously given to Medicare beneficiaries using an ACO.

Patient Centered Medical Homes are being established to help place these groups under one roof to conveniently provider their services. This requires an accreditation to prove the ACO has achieved proper functionality as such an organization, and can administer care in their own facility. ACOs are still structured fairly loosely to allow for freedom in creating a better system for individuals, though this can be read as a shortcoming in many ways. By being all in one group, monitoring expenses and health care for each treated individual, ACOs are attempting to increase the level of quality in Medicare treatment and lower the costs accrued by the providers.

Medicare recipients who use an ACO are not limited to getting health care services exclusively through their ACO. Eligible individuals can still see any provider they choose while being treated through an accountable care organization. Also, if the patients of an ACO show positive health outcomes, the practice will share any remainder of savings with taxpaying citizens, hence being part of the Medicare Shared Savings Program.

ACO Growth in Florida

In July 2012, it was announced that 88 more medical groups had been added to the ACO list all over the nation, including ten groups from Florida. Health care providers in Florida, most of them physicians, totaled nearly 1,300 doctors earned the ACO designated title by the federal government. Given the involvement of this many providers throughout the state, it is likely that many more Medicare beneficiaries in Florida will be using this kind of care. The ten recently added groups include various regions of the state, and add to a total of 154 around the country – only created a year and a half ago in January 2011.

The most recently added groups, active as of July 1, 2012 include the following in the state of Florida:

  • Accountable Care Coalition of Northwest Florida, LLC. Pensacola. 60 physicians.
  • Accountable Care Partners, LLC. Jacksonville. 65 physicians.
  • Allcare Options, LLC. Manatee County. 198 physicians.
  • Florida Medical Clinic ACO, LLC. Zephyrhills. 153 physicians.
  • FPG Healthcare, LLC. Orlando. 142 physicians.
  • HealthNet, LLC. Boynton Beach. 55 physicians.
  • Integrated Care Alliance, LLC. Gainesville. 115 physicians.
  • Medical Practitioners for Affordable Care, LLC. Melbourne. 126 physicians.
  • Palm Beach Accountable Care Organization, LLC. West Palm Beach. 337 physicians.
  • Reliance Healthcare Management Solutions, LLC. Tampa. 36 physicians.

ACO Criticism

ACOs have been accused heavily of being a way to “ration” health care to Medicaid beneficiaries and also gathered speculations of high start-up costs and excessive yearly expenses to keep the ACOs in operation. The Independent Payment Advisory Board (IPAB) has been branded as a panel for rationing by the GOP, and are in the middle of trying to repeal the Medicare cost-control board. The Affordable Care Act specifically addresses this concept, and has made it illegal for IPAB to ration care, make Medicare recipients pay, or eliminate benefits. IPAB has also received doubts from the other political party, explaining that Congress should have more of a say in Medicare regulations.

These organizations also create some challenges when it comes to violating antitrust laws, if they end up increasing costs by lowering the amount of competition in the health care system and provide unsatisfactory care. ACOs are currently under review by the Department of Justice, as spawned by the federal trade commission. Obviously the new system is receiving a good deal of scrutiny, but it has been created with positive intentions. A radical implementation and change to the health care system is sure to receive a large number of doubts, though more and more doctors in Florida and throughout the nation are joining ACOs and expanding the option for individuals with Medicare.

Top