The Next Steps for Accountable Care Organizations, Bundled Payments, and Health Reform

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The Next Steps for Accountable Care Organizations, Bundled Payments, and Health Reform
The University of Texas at Dallas
The American Health Care System
HGMT 6320

The Next Steps for Accountable Care Organizations, Bundled Payments, and Health Reform

With the enactment of the Patient Protection and Affordable Care Act (PPACA) in March 2010, health care reform has become the law. The legislation will extend health care coverage to more citizens, stabilize health insurance markets, enhance regulation and consumer protection, and improve the affordability and quality of health care in the United States. Changes in payment system of health care proposed by PPACA have led to the development of Accountable Care Organization (ACO). This paper will address how ACOs and the bundled payments system will impact the future of health care. The ACO is a health care organization which provides accountability for quality, cost, and care for medical beneficiaries with single entity providers that are responsible for delivering care. The ACO-model builds on the Medicare Physician Group Practice Demonstration and the Medicare Health Care Quality Demonstration, established by the Medicare Prescription Drugs Improvement and Modernization Act of 2003. Under the Affordable Care Act, the U.S. Department of Health and Human Service (HHS) released new rules that benefit doctors, hospitals, and other health care providers of better care for Medicare patients through ACOs on March 31, 2011(U.S. Department of Health & Human Services, 2001). According to the Centers for Medicare & Medicaid Services’ (CMS) administrator Donald Berwick, MD, “An ACO will be rewarded for providing better care and investing in the health and lives of patients. ACOs are not just a new way to pay for care but a new model for the organization and delivery of care” (Penton Media., 2011). The new model, which is called the “Pioneer Accountable Care Organization,” is to improve the quality of



References: Becker, Epstein & Green, P.C (2011) “HEALTH REFORM: CMS Innovation Center Announces Four Models in Bundled Payments for Care Improvement Initiative,” Retrieved from http://www.ebglaw.com/showclientalert.aspx?Show=14876 Carroll, Aaron FierceHealthcare, (2011) “CMS, OIG to relax self-referral, anti-kickback laws with ACO waivers,” Retrieved from http://www.fiercehealthcare.com/story/cms-oig-relax-self-referral-anti-kickback-laws-aco-waivers/2011-10-21 Foster, David Gorman Health Group Blog (2011), “CMS Innovations: Bundled Payments for Care Improvement Program,” Retrieved from http://blog.gormanhealthgroup.com/2011/09/01/cms-innovations-bundled-payments-for-care-improvement-program/ Hernandez, AF, Greiner, MA., et Leyva, Carlos and Deborah Leyva (2009). “HITECH Act Summary,” Retrieved from http://www.hipaasurvivalguide.com/hitech-act-summary.php Marathon Medical Communications, Inc McClellan, Mark and Aaron Mckethan (2009). “The Challenge of Health Care Reform: Texas and Nation” Engelberg Center for Health Care Reform, Retrieved from http://www.utsystem.edu/ohr/AQHCT/keynote.pdf Numberof, Rita E U.S. Department of Health & Human Services. (2001), “Affordable Care Act to improve quality of care for people with Medicare,” Retrieved from http://www.hhs.gov/news/press/2011pres/03/20110331a.html U.S United States Government Accountability Office. (2011) “Health Care Delivery Features of Integrated Systems Support Patient Care Strategies and Access to Care, but Systems Face Challenges,” Retrieved from http://www.gao.gov/new.items/d1149.pdf Primary Care Associates. (2008) “Physician’s Advocate,” Retrieved from http://pcareno.net/PDF/2008-11-19.pdf Fisher, Elliott S., Staiger, Douglas O., Bynum, Julie P.W Massachusetts Medical Society (2008) “Summary: Episode-Based Payment,” Retrieved from http://www.massmed.org/AM/Template.cfm?Section=Home6&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=27550 Nixon Peabody LLP Penton Media. (2011) “Sebelius, Berwick Announce ACO Initiative,” Retrieved from http://homecaremag.com/news/aco-accountable-care-organizations-proposal-20110401/

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