Accountable Care Organizations

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Information about Accountable Care Organizations
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Published on February 26, 2014

Author: johnr1027

Source: authorstream.com

Accountable Care Organizations and the Medicare Beneficiary ___________________________________________ Implications for Durable Medical Equipment Suppliers : Accountable Care Organizations and the Medicare Beneficiary ___________________________________________ Implications for Durable Medical Equipment Suppliers HHS 6980 - Seminar John Russell Summer 2011 Introduction to the Problem : Introduction to the Problem Government sponsored health programs face many challenges Fragmented provider systems increase patient risk Baby Boomers increasingly attaining eligibility Shortage of primary care providers Skyrocketing healthcare costs PPACA: PPACA Patient Protection and Affordable Care Act ( PPACA of 2010) Medicare Initiatives DHHS/CMS Accountable Care Organizations (ACO ) Shared Savings Program (January 1, 2012) DMEPOS: DMEPOS Durable Medical Equipment, Prosthetics, and Orthotics Suppliers (DMEPOS ) MMA 2003 Competitive Bidding Research Purpose/Objectives: Research Purpose/Objectives Applied Research Project ACOs and DMEPOS Current information is scattered No studies on the ACO/DMEPOS relationship Bring together existing information Frame around ACO/DMEPOS relationship Research Questions: Research Questions What is an ACO? How does the shared savings program work and can DMEPOS participate in the program? What implications does the formation of ACOs have for the healthcare industry? Would DMEPOS benefit from strategic alliances with ACOs to maintain, or possibly grow, revenues from the Medicare Beneficiary market? Methods: Methods Study did not involve actual subjects E xamination of the literature Government documents Research of others from industry periodicals Summary of ACO Model/Shared Savings Program Implications Strategic Business Alliances ACO Model: ACO Model Service providers and suppliers eligible to participate: ACO professionals in group practice arrangements Networks of individual practices of ACO professionals Partnerships or joint ventures between hospitals and ACO professionals Hospitals employing ACO professionals Other groups of providers and suppliers as the Secretary determines appropriate Shared Savings Program : Shared Savings Program Two Programs Both are 3 years in length Considers risk tolerance of participants Shared Risk Program Full participation in losses/savings Limited Risk Program No share in losses in years 1-2 Convert to full participation in year 3 ACO Implications for the Industry: ACO Implications for the Industry Advantages Increased efficiencies of healthcare system Improved quality of care Reduction in fraud Concerns Contraction of number of providers Not quite fully integrated Strategic Alliances: Strategic Alliances Include DMEPOS in ACO/Shared Savings Assure the appropriate application of DME Further reduction of costs Improve quality and access of care Results: Results ACO Implication for Industry Contraction Improved care Lower costs DMEPOS Do not meet eligibility for ACO model Can’t participate in shared savings program Will benefit from strategic alliances with ACO Discussion: Discussion Opportunities DMEPOS lobby DHHS Secretary “Other groups of providers and suppliers as the Secretary determines appropriate” Fits the defined purpose of improved quality of care Implications of Study No implications itself Summary of ACO model & implications Discussion: Discussion Limitations Secondary research only No contact for opinions Government Providers/Suppliers ACO model yet to be finalized Revisions/Further instructions are expected References : References Federal Registry, Department of Health and Human Services. (2011, April). Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations and Medicare Program: Waiver Designs in Connection With the Medicare Shared Savings Program and the Innovation Center; Proposed Rule and Notice. (Vol. 76, No. 67). Retrieved from http://edocket.access.gpo.gov/2011/pdf/2011-7880.pdf Isnar , R. (2010). Tighter Enrollment Standards for Medical Equipment Suppliers. Journal of Health Care Compliance , 12(6), 5-66. Retrieved from EBSCO host . Cabin, W. D. (2011). Accountable Care Organizations: The Push for More Physician Control of Home Care and Hospice? Home Health Care Management & Practice , 23 (2), 144-145. doi:10.1177/1084822310389137 Berwick, D. (2010, September 13). America’s Health Insurance Plans . Address at the Medicare Conference, Washington, D.C. Retrieved from http://www.cms.gov/apps /media/press /speech. asp?Counter =3838& intNumPerPage =10&checkDate =& checkKey =& srchType =1&numDays=3500&srchOpt=0&srchData= & keywordType = All&chkNewsType =11&intPage=& showAll =& pYear =&year=& desc =& cboOrder =date  Allen, B., Levin, D. C., Brant- Zawadzki , M., Lexa , F. J., , &  Duszak , R. (2011). ACR White Paper: Strategies for Radiologists in the Era of Health Care Reform and Accountable Care Organizations: A Report From the ACR Future Trends Committee. Journal of the American College of Radiology , 8 (5), 309-317. doi:10.1016/j.jacr.2011.02.011 Iwashyna , T. J., , & Christie, J. D. (2007). Low Use of Durable Medical Equipment By Chronically Disabled Elderly. Journal of Pain and Symptom Management , 33 (3), 324-330. doi:10.1016/ j.jpainsymman . 2006.08.012 Pande , A. H., Ross- Degnan , D., Zaslavsky , A. M., , & Salomon, J. A. (2011). Effects of Healthcare Reforms on Coverage, Access, and Disparities. American Journal of Preventive Medicine , 41 (1), 1-8. doi:10.1016/j.amepre.2011.03.010. Accountable Care Organizations and the Medicare Beneficiary ___________________________________________ Implications for Durable Medical Equipment Suppliers : Accountable Care Organizations and the Medicare Beneficiary ___________________________________________ Implications for Durable Medical Equipment Suppliers Thank you HHS 6980 - Seminar John Russell Summer 2011

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