KMyrvik-HI215-02 Unit 9 Assignment

KMyrvik-HI215-02 Unit 9 Assignment

• 1.
  Advance Payment ACO Model KMYRVIK-HI215-02
• 2.
  Advance Payment ACOModel The Advance Payment Model is designed for physician-based and rural providers who have come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Through the Advance Payment ACO Model, selected participants will receive upfront and monthly payments, which they can use to make important investments in their care coordination infrastructure. On Nov. 2, 2011, the Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), published a final rule in the Federal Register implementing an Affordable Care Act provision to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program (Shared Savings Program) will reward ACOs that lower their growth in health care costs while meeting performance standards on quality of care. Provider participation in an ACO is purely voluntary, and Medicare beneficiaries retain their current ability to seek treatment from any provider they wish (Centers for Medicaid and Medicare Services 2013).
• 3.
  Summary of theAdvance Payment ACO Model The Advance Payment ACO Model will test: • Whether providing an advance (in the form of up-front and monthly payments to be repaid in the future) will increase participation in the Shared Savings Program, and • Whether advance payments will allow ACOs to improve care for beneficiaries and generate Medicare savings more quickly, and increase the amount of Medicare savings. The Advance Payment ACO Model is meant to help entities such as smaller practices and rural providers with less access to capital participate in the Shared Savings Program. The Advance Payment Model was initially only made available to ACOs who began participation in the Medicare Shared Savings Program on April 1, 2012 or July 1, 2012. On June 12, 2012, CMS announced that it will also accept applications from ACOs that are applying for participation in the Shared Savings Program with a start date of January 1, 2013 (Centers for Medicare and Medicaid Services 2013).
• 4.
  Structure of Payments Underthe Advance Payment ACO Model, participating ACOs receive three types of payments: • An upfront, fixed payment: Each ACO receives a fixed payment. • An upfront, variable payment: Each ACO receives a payment based on the number of its preliminarily prospectively-assigned beneficiaries. • A monthly payment of varying amount depending on the size of the ACO: Each ACO receives a monthly payment based on the number of its preliminarily prospectively assigned beneficiaries (Centers for Medicare and Medicaid Services 2013). An ACO is comprised of a group of providers who organize themselves to take on the shared responsibility of administering care to a group of patients while seeking to improve quality of care, lowering of healthcare costs, and increased access to care (Jones, J., 2015)
• 5.
  ACO’s must deliverquality care at a lower price point and would prevent reimbursement. The Pioneer ACO Model will test the impact of different payment arrangements in helping these organizations achieve the goals of providing better care to patients and reducing Medicare costs (Centers for Medicare and Medicaid Services 2013). In Medicare’s traditional fee-for-service payment system, doctors and hospitals generally are paid for each test and procedure. That drives up costs, experts say, by rewarding providers for doing more, even when it’s not needed. ACOs don’t do away with fee for service, but they create an incentive to be more efficient by offering bonuses when providers keep costs down. Doctors and hospitals have to meet specific quality benchmarks, focusing on prevention and carefully managing patients with chronic diseases. In other words, providers get paid more for keeping their patients healthy and out of the hospital (Kaiser Family Foundation 2015). One of the key challenges for hospitals and physicians is that the incentives in ACOs are to reduce hospital stays, emergency room visits and expensive specialist and testing services — all the ways that hospitals and physicians make money in the current fee- for-service system (Gold, J., 2014)