Medicare Reform through Accountable Care Organizations

Medicare Reform

Accountable Care Organizations (ACOs), which have been around for several years, are an attempt to provide quality medical care for less money. The Centers for Medicare and Medicaid Services (CMA) define an ACO as “an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.”

An organization is made up of primary care physicians, specialists, home health care providers, and hospitals. They communicate with each other – in partnership with you – to make your healthcare decisions.

An ACO will prevent expensive duplication of tests, which can occur if you are seeing different doctors, and your care is not coordinated among them. Another benefit: you will not have to fill out a patient information form every time you go to a new participating caregiver. Your information will be stored electronically by the ACO.

Under the CHRONIC (Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care) Act signed recently, a new program has been established that allows some ACOs to incentivize patients who come in for primary appointments but paying them up to $20 per visit.

Who is eligible?

If you are currently a traditional Medicare beneficiary, you may be assigned to an ACO. Members of a Medicare Advantage plan are not eligible.

An ACO is not allowed to tell you to see a particular provider and it cannot change any of your Medicare benefits. You have all the rights that all Medicare beneficiaries have. Your information will be protected for privacy and security.

While the sharing of your medical information is a benefit in the long run, you may request (from Medicare) that certain information not be shared.

You will receive a notice if you are in an ACO program. Participating caregivers must also display a poster in offices and waiting areas telling you they are an ACO member and have asked Medicare for your medical information.

ACO participants have to agree to be in the organization for three years or more. The ACO must accept at least 5,000 beneficiaries.

Cost savings and quality care

Accountability means transparency, so an ACO must have a method of comparing its care delivery against CMS benchmarks. The ACO will share in any savings realized for the Medicare program. ACOs may also receive bonuses for keeping costs down while maintaining a level of quality care.

The sharing of information about your healthcare with the goal of improving your care and limiting unnecessary expenditures is reform in a specific area of Medicare, but one which should achieve savings without compromising quality care.

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