NURS 8100 With Posting Instructions in Mind, Select Either the Individual Mandate or Accountable Care Organizations as the Focus of your Discussion This Week
NURS 8100 With Posting Instructions in Mind, Select Either the Individual Mandate or Accountable Care Organizations as the Focus of your Discussion This Week
In this week’s discussion, I chose to discuss Accountable Care Organizations because their formation and goals align with those of my current organization. According to authors, Briggs, Fraze, Glick, Beidler, Shortell, and Fisher, the creation of Accountable Care Organizations (ACO) has led to an increase in motivation for delivering quality preventative care services ( Briggset. al., 2019). The Centers for Medicare & Medicaid Services states that ACOs are created when groups of healthcare providers and facilities work together in providing quality care services to the patients they service (Ulrich, 2012).
An unintended consequence of ACOs could be the formation of entities that will impact the cost of services they provide to increase, thereby reducing access for those who cannot afford the new rates. This might happen as a result of the different healthcare segments pulling together their resources thereby creating an environment that demands higher costs. These costs are in turn transferred to the fees the patients pay for the services.
In relation to my current organization, having an ACO would enable us to service more patients and provide an even more efficient service. ACOs would create access for underserved patients. It would be extremely beneficial to the morale of the healthcare staff to see that they can now service more of the less fortunate.
References
Briggs, A. D. M., Fraze, T. K., Glick, A. L., Beidler, L. B., Shortell, S. M., & Fisher, E. S. (2019). How Do Accountable Care Organizations Deliver Preventive Care Services? A Mixed-Methods Study. Journal of General Internal Medicine, 34(11), 2451–2459. https://doi.org/10.1007/s11606-019-05271-5
Teno, J. M., Mitchell, S., Belanger, E., Bunker, J., & Gozalo, P. L. (2021). Accountable Care Organizations (ACOs) Could Potentially Improve the Quality of Care in Those Afflicted With Dementia. Journal of Pain and Symptom Management, 62(2), e1–e2. https://doi.org/10.1016/j.jpainsymman.2021.04.003
Ulrich, B. (2012). Accountable Care Organizations: What They Are And Why You Should Care. Nephrology Nursing Journal, 39(6), 427.
Discussion: Unintended Consequences of Health Care Reform
The PPACA of 2010 fostered new provisions for health care and the structure of health care delivery. The individual mandate to obtain insurance is one provocative provision. While this provision attempts to increase access to health care, it raises questions on how the existing system could sustain the potentially large influx of newly insured individuals.
Another provision calls for new models of health care provider organizations to ensure delivery efficiency and continuity of care. In this week’s media presentation, Dr. Kathleen White discusses the accountable care organization, which comprises a group of providers coordinating care across a variety of institutional settings. Yet becoming an accountable care organization may present a number of challenges.
This week’s Discussion builds on Week 1, continuing the examination of those societal and organizational contexts that influence health care reform. The unintended consequences of reform policy on the health care system are also considered.
To prepare:
Review this week’s media presentation and the other Learning Resources focusing on how reform may lead to improved quality, greater access, and reduced cost of care. Also think about the unintended consequences that may arise as a result.
Consider the information presented about the individual mandate and accountable care organizations. What are some questions or concerns you might have regarding the individual mandate? What are the pros and cons associated with becoming an accountable care organization?
With posting instructions in mind, select either the individual mandate or accountable care organizations as the focus of your Discussion this week.
By Day 3
Post a cohesive response that addresses the following:
In the first line of your posting, identify the topic you have selected—either the individual mandate or accountable care organizations. With regard to this topic, describe one or more positive results that could be achieved, and one or more unintended consequence(s) that organizations or individuals may experience.
Briefly evaluate issues on the topic that may be a consideration for the organization you work in and the nursing profession.
Read a selection of your colleagues’ postings.
By Day 6
Respond to at least two of your colleagues in one or more of the following ways:
Ask a probing question, substantiated with additional background information, evidence or research.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Note: Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.
Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.
Submission and Grading Information
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. 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 both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. The healthcare payment process is undergoing a dramatic transformation as payers and providers shift from volume to value. While stakeholders are currently piloting many different value-based care models, accountable care organizations are among the most popular and successful strategies to date. 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. ACO participants also agree to take on responsibility for the total costs of care for their patients. ACOs that reduce the total costs of care for their patient populations can share in the savings with the payer. In certain models, they may also be liable to pay back losses if their costs exceed their spending benchmarks (Moore et al., 2017). Policymakers and healthcare leaders believe tying financial incentives to care quality, patient outcomes, and care coordination through ACOs is a key solution for fixing the inefficient fee-for-service system. The programs encourage providers to partner with others across the care continuum. Some providers are formally acquiring to gain control over a wide range of services, achieve economies of scale, and access the technology, data, and clinical capabilities of their peers. In fact, ACOs are and are likely to continue to be a major player in the value-based care and payment transformation. When all the parts work together, providers in an ACO can bring down costs and improve care quality while earning incentive payments. HMOs, on the other hand, seek to cut costs by setting fixed prices for services, which may encourage providers to reduce utilization or skimp on care in an effort to stay under the cap(Colla et al., 2018).
References
Colla, H., & Fisher, E. S. (2018). Moving forward with accountable care organizations: some answers, more questions. JAMA internal medicine, 177(4), 527-528. https://doi.org/10.1001/jamainternmed.2016.9122
Moore, K. D., & Coddington, D. C. (2017). Accountable care the journey begins. Healthcare Financial Management, 64(8), 57-63. Retrieved from https://www.proquest.com/trade-journals/accountable-care-journey-begins/docview/746684537/se-2?accountid=14872
Response
This is insightful Edwige, Bottom of FormAccountable Care Organizations (ACOs) are groups of doctors, hospitals, and other healthcare providers who come together to provide coordinated care to their patients (Colla & Fisher, 2018). The goal of ACOs is to improve the quality of care while also reducing costs. One way that ACOs achieve this goal is by sharing information about their patients (Meyer et al., 2017). This allows the providers in the ACO to work together to come up with a plan for each patient that meets their individual needs. ACOs can also use this information to track how well they are meeting quality and cost goals (Lewis et al., 2019). ACOs are funded in part by Medicare and Medicaid. However, they are also open to patients who have private insurance. ACOs have been shown to improve the quality of care while reducing costs. For example, a study published in Health Affairs found that ACOs were associated with improvements in quality of care and reductions in spending on Medicare patients.
References
Colla, H., & Fisher, E. S. (2018). Moving forward with accountable care organizations: some answers, more questions. JAMA internal medicine, 177(4), 527-528. https://doi.org/10.1001/jamainternmed.2016.9122
Lewis, V. A., Schoenherr, K., Fraze, T., & Cunningham, A. (2019). Clinical coordination in accountable care organizations: A qualitative study. Health care management review, 44(2), 127. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461217/
Meyer, C. P., Krasnova, A., Sammon, J. D., Lipsitz, S. R., Weissman, J. S., Sun, M., & Trinh, Q. D. (2017). Accountable care organizations and the use of cancer screening. Preventive medicine, 101, 15-17. https://doi.org/10.1016/j.ypmed.2017.05.017
You are right that Medicare is really focused on the patient care experience. Healthcare organizations are being held accountable and billing is not just billing anymore. The Centers of Medicare and Medicaid Services implemented the Consumer Assessment of Healthcare Providers & Systems (CAHPS) Hospice Survey (CMS, 2020). The CAHPS Hospice Survey is goes out to the patient’s primary caregiver a few months after the passing of the patient. The survey addresses questions regarding to the patients care such as symptom management, communication with the interdisciplinary team, primary caregivers experience with the interdisciplinary team, overall rating of the hospice team, and willingness to recommend the hospice company to others. Hospice companies are required to participate in the CAHPS Hospice Survey to receive their full Annual Payment Update (APU).
Currently our hospice company has a Performance Improvement Project that is focusing on the patient’s pain management and response. The reason the pain quality initiative was started because the CAHPS Hospice Survey were identifying a deficiency targeting patients’ pain. The PI Project was initiated at the beginning of the year to focus on providing quality care and increase hospice scores. All patients identified with a pain level of 4/10 are broadcasted through the email system for proper identification. The RN Case Manager and the rest of the interdisciplinary team are responsible to monitor the patients pain level, medications effectiveness, and open communication with the hospice team, medical director, patient, and family. Patient will be seen every day and will be monitored in the morning and the evening. The patient and primary caregiver are advised to contact the IDT before 5 pm and the triage team after 5 pm for any increase in pain. The PI Project is showing much progress identifying and managing patients’ pain plus increased communication with the primary caregiver. These are all efforts to provide great care to the patient and families, but it also ensures that the healthcare organization also gets compensated appropriately by CMS.
References
Centers of Medicare and Medicaid Services. (2020). CAHPS hospice survey. https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/CAHPS-Hospice-Survey#:~:text=The%20Hospice%20CAHPS%C2%AE%20Survey%20started%20national%20implementation%20in,administration%20will%20occur%20several%20months%20after%20the%20death.