...Abstract Accountable Care Organization is a healthcare organization characterized by a payment and care delivery mode. lt seeks to tie provider reimbursements to a quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers form an ACO, which then provides care to a group of patients. The ACO may use a range of payment methods, (e.g. capitation, fee-or-service with an asymmetric or symmetric shared savings). The ACO is accountable to the patients and the 3rd party payer for quality, appropriateness, and efficiency of the health care provided. The Centers for Medicare and Medicaid Services (CMS), an ACO is considered an organization of health care providers that agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program. This paper identifies the differences between HMO’s and ACO’s but also correlates the similarities between ACO’s and Patient Center Medical Home (PCMH). The ACO’s place a degree of financial responsibility on the providers in hopes of improving care management and limiting unnecessary expenditures while continuing to provide patients freedom to select their medical services. The success and challenges of ACO are identified and explored. By increasing care coordination, ACO’s can help reduce unnecessary medical care and improve health outcomes, leading to a decrease in utilization...
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...Indeed, Accountable Care Organization is a critical element in today’s marketplace. “Accountable care organization (ACO) or accountable care system (ACS) is an entity that can implement organized processes for improving quality and controlling the cost of care, and can also then be held accountable for these care results and the resultant costs associated with outcomes”. (Berkowitz 2017, page. 37). ACOs are constituted by a group of providers, hospitals and other healthcare organizations who voluntarily coordinate high quality of care for insured patients, Medicare and Medicaid patients. Additionally, ACOs are responsible for inpatients, outpatient, palliative care and long-term care. It seems that ACOs focused more on the delivery of a suitable care rather than the...
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...Accountable Care Organizations May 5, 2012 Accountable Care Organizations represent a strategy outlined within the Affordable Health Care Act to control costs and improve quality. They require partnerships between providers, hospitals, and communities. There are challenges in health systems where private practice is the predominant practice structure. Key issues and challenges to an effective ACO are cost reduction and utilization management, business model shifts, risk sharing and population management, consolidation, a changing role of IT and value of data, physician integration, clinical process improvement, and consumerism and the patient. How to reduce cost is a question that has been pursued, and it needs to be looked at, as well as utilization of management. Does this mean that homes for critically ill children or a hospital that cares only for transplant patients is becoming the future of health care in the USA? Why Accountable Care Organizations? No one will dispute the high cost of health care in the United States. Critics often say that it is the result of how health care providers are paid. They claim that—with a fee for each service— this results in increased and wasteful spending. Critics say that this system rewards providers just for doing more procedures, rather than for providing efficient and high-quality care (Matthews, 2012). In an effort to handle this problem, the United States Government has passed legislation: The Affordable...
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...Accountable Care Organizations: Key to Transforming Healthcare? The Talia Goldsmith, MHA Candidate 2011 Suffolk University Sawyer Business School HLTH 890AE: Healthcare Strategic Management Professor Richard H. Gregg, M.A., M.B.A. April 28, 2011 Table of Contents Objective .....................................................................................................................................3 Introduction ..............................................................................................................................3 Overview of ACOs as a Mandate and an Opportunity for Healthcare Organizations............................................................................................................................4 Examples of Missions, Visions, Values and Goals for ACOs........................................6 Mission ................................................................................................................................................. 6 Vision ....................
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...com/downloads/hcs-325-week-1-individual-assignment-roles-functions-paper/ For More Courses and Exams use this form ( http://hwguiders.com/contact-us/ ) Feel Free to Search your Class through Our Product Categories or From Our Search Bar (http://hwguiders.com/ ) Roles and Functions Paper Today’s health care needs a manager who has understanding of management and the skills needed to manage within the health care environment. This management refers to activities included in planning, organizing, leading and controlling of an organization. The manager must respond and adapt to the changes in an organization required by the needs of the patient population it serves. Managers must be accountable not only in decision-making, but productivity, cost containment, safety, confidentiality, etc. An effective manager must be accountable, create a quality work environment, and understand the value of a diverse workplace as well as other important functions that contribute to effective management. Although the roles of manager vary, all managers in any health care organization or any organization for that matter must manage effectively using the management process, being accountable for themselves and others, using the principles of effective time management, networking, recognizing and supporting the department of intellectual capital and other essentials of successful management. To be able to achieve this, a manager must understand the business environment, and the people that will...
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...important, accountability. Holding people accountable for their actions or lack thereof is important for many reasons. It entails the procedures and processes by which one party justifies and takes responsibilities for its actions. Accountability simply reflects the achievement of sustainable outcomes (Porter-O’Grady & Malloch, 2007). Although it is meant to be a positive process and should be a benefit for the organization, it can sometimes affect the work environment. Why is accountability important in the health care industry? In health care, accountability does not just begin with the front line providers, everyone in the organization is important to making sure everything runs smoothly. This starts from the bottom with those that order supplies and even those that register patients. If patients are registered incorrectly, they may receive the wrong treatments which could result in a very bad situation. Also, if the necessary medical supplies are not on hand, patients could again be put at risk. Unfortunately in health care, small mistakes can lead to life threatening outcomes. How is an employee’s accountability measured in the health care industry? In order for someone to be held accountable, it must first be determined who should be held accountable, which can sometimes be difficult. “In health care, like other industries, numerous “loci” of accountability-parties that can be held accountable or gold others accountable- have been identified. “Accountors” may...
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...Accountable Care Organizations (ACO) When some doctors, healthcare providers and hospitals get together to give their patients a high quality and well coordinated care, forms an organization. This organization is known as Accountable care organizations. ACOs are based on integrated systems of delivery and posses a range of doctors and physicians, virtually connected. The aims of this organization is to look after the patient and deliver them right treatment at the right time and also coordinate all the efforts so not to overlap or repeat anything. This results in reduction of the medical errors. This procedure saves the cost of medical treatment. Another important aim is to stop spread of diseases through preventive measures and spreading education. The most important objective is to bring reduction in costs and reduce the waste of money in healthcare system. The conditions which will result in ACOs,if physicians and other related professionals are practicing in a group, or they have form a network or there exists a collaborations between physicians, hospitals and professionals. If these conditions exist anywhere it will be called as ACOs. The requirements any ACOs need to fulfill are, it must have a formal legal framework to distribute the savings, it should possess a minimum of 5,000 numbers of beneficiaries, it should agree to take part for three years or so. An organization must fulfill these requirements to form a ACOs. (American Hospital Association, 2010) This new treatment...
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... Costs matter in healthcare industry, and often, Medicaid have cut the physicians’ charge down to forty percentage of Medicaid care. Nevertheless, Medicaid reimbursement cuts are even lower, in which have affect the physicians’ decision whether to accept new Medicaid patient or not. As this matter continues, solutions are needed to restraint these matters into hands and improves the quality of services and cares. First solution is the bottom-up approach, this method usually developed from the below where the manager and sub-unit departments level to review and identify the problems within the organization. For example, as insurers fire a reimbursement program to hospital and/or physician, they enquires them to down-charges or substitute the treatments, surgeries, or any services for patient, the physician seem to be discourages and refuses to negotiate. In this case, the cost seem to be the issue that cause a rift between physician and patient through the Medicaid Reimbursement program. If, it was accepted and treated, the quality of care and services may not be what patients wanted to be and lead to mistrust....
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...Salter wants me to analyze the Affordable Care Act of 2010 as it relates to Accountable Care Organizations. Becoming an ACO has several advantages as well as disadvantages. In my opinion, we can get Bobcat out of the red by becoming an ACO, meaning putting emphasis on providing quality and efficiency. According to Dr. Michael Nowicki, Affordable Care Act (ACA) of 2010 places significant restrictions on the expansion of physician-owned hospitals. Accountable Care Organizations (ACOs) seems like a perfect solution for under ACA because ACOs are not owned by the physicians. According to Dr. Nowicki, Accountable Care Organization (ACO) is a healthcare organization that coordinates care among healthcare organizations and physicians. Therefore, ACOs are not owned by the physicians. The risk is shared by all parties involved. This can attract more physicians to become part of Bobcat Integrated Healthcare System. ACA also plans to reduce unnecessary hospital readmissions and hospital-acquired infections by using financial penalties to the responsible healthcare organizations. A key element of an ACO is that some portion of its reimbursement is tied to accountability. An ACO is accountable not only to the patients but also to the third party payers for the quality, cost and efficiency of...
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...Bay Area Regional Accountable Heath System Marketing Plan As a long-term marketing and strategic director at Oakland Alameda Regional Hospital a 250-bed hospital, with a busy emergency room and an outpatient primary care satellite allows an understanding of an effective marketing strategy for Bay Area Regional Accountable Heath System (Berkowitz, 2011, p. 38). An Accountable Care Organization (ACO) is dynamic within the elements of the marketing strategies. An Accountable Care Organization (ACO), is “an entity that can be implement organized processes for improving quality and controlling the costs of care and can also then be held accountable for these care results and the resultant costs associated with the outcomes” (Berkowitz, 2011, p....
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...success but also for the organization they work for. Even if things do not turn out to be as expected it is good for that person to stand for their actions and becoming responsible for the results in order for identify what the problem was and how it might be fixed. The important thing is to be able to not make the same mistakes if our results were not good. We need to keep in mind that human beings make mistakes on a daily basis and what makes them successful is learning from those mistakes done. In health care accountability is definitely more important because you are dealing with patient’s health and lives. Being accountable in any health care organization it means that you are responding to patient, community, political, and commercial expectations. At all levels of the healthcare system important decisions are taken with regard to the quantity and the way in which the resources are used (Nunes 2011). Health care professional’s objective is to always offer the best quality of health care and access to resources to be able to meet those objectives. Each year over 100,000 people die due to health care mistakes that most of the times could have been prevented. Even though there have been different types of efforts to improve patient safety and improve health care delivery, errors keep on happening on a daily basis. You might ask yourself why things like these still happen. The answer is easy and straight forward, because no one is being accountable for their actions. Physicians...
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...The Importance of Accountability Paper Michelle Payden-Wright HCS/475 March 2, 2015 Dr. Lawrence Fergus The Importance of Accountability Paper Accountability is important in the health care industry; it holds an individual accountable day in and day out for his and her own tasks. Holding a person accountable for their actions can also assist in creating accountability for the department, unit, organization, and industry level of the organization. Accountability is considered to be a performance management system to improve and measure quality in the health care industry (O'Hagan & Persaud, 2009). “The good leader works hard to make sure that there is little transfer of accountability from the staff to the leader when it comes to accountable decision making” (Porter-O'Grady & Malloch, 2007, p.116 ). In order to be accountable an individual must be direct with his or actions, decisions and outcome, and in the health care industry there is lack of clarity when it comes to actions, responsibility and results, it is up to the leader to form the ideas that will support the decisions being made. Being accountable is when a person knows what his or her work is worth. Employee’s accountability is measured in the health care industry by setting goals that can be tracked, and employer feedback is also helpful. The "U.S. Office of Personnel Management" (n.d.) website discusses how setting specific goals for each employee will help measure the employees’ performance accurately...
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...Accountability is one of the most essential traits that a person can acquire. Accountability can also be known as honesty. Accountability is very significant in the health care industry. There is not an organization that is able to function properly without accountability. There are new facts that prove that accountability affects an organization worse than any other factors and has cost the health care industry billions of dollars and these numbers continue to rise on a daily basis. According to Porter-O’Grady (2007), accountability is the most commonly used and misinterpreted element of management now. This paper will discuss the importance of accountability, how an employee’s accountability is measured in a health care industry, how accountability applies to the ethical considerations in leadership and management, what a checks-and-balances process looks like in a successful organization, how accountability affects an organization's working culture, and how to maintain a positive working culture and avoid a working culture of blame. Why is accountability important in the health care industry? Accountability is vital since it helps improve the organization with performance management, the improvement of employees, and improvement of procedures. Organizations are able to grow when accountability is shown in the organization. This is including all departments, employees, administration staff, and units. Everyone has their own accountability role and is responsible for that role. If anyone...
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...Nursing Professional NRS-430 April 07, 2011 Accountability of Nursing Professional Every health care member is accountable to their Profession ,Public ,Self,Clients,and health care agency.Accountability means they are able to explain the reasons behind their actions. Accountability facilitates self assessment and assume ownership of job role. Porter-O’Grady & Malloch(2007) replaced respnsibility with accountability. The word ‘ Responsible ‘ means,it ,make the workers feel like they need to complete a job within certain time.Accountability make the workers programe their job and take ownership of it. They can eventually feel proud about their performance.American nurses association stated that the nurse will be accountable for their actions and their judgment.(ANA2001P1).Accountability is a legal obligation.It applies to every one involved in the health care.According to the health portability and accountability act, the nurse should not ignore the patients wishes.Nursing shortage will impact the future of health care.This make the health care institution uses the non-licensed individuals to be patient care givers.This inturn will place more ethical and legal responsibility on RNs .RN position will be as a leader or supervisor in the health care industry. Nurses are accountable to the clients. Nurses allow clients to participate in nursing care activities and planning.Nurses serve as a client advocate, when the need arises.Nursing task will be performed...
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...that have had an effect on shaping and defining an organization that I previously worked for. It will also examine how the need for additional accountability has affected the behavior of the organization. One of internals factors that has affected on our organization was communication. Since we were a small company (one physician and four employees), good communication was key. We had to keep relationships open and strong. We depended on our monthly meetings, training literature and the reviewing of policies to keep us current on issues and to ensure we were all on the same page. When you "provide sufficient instructions to your subordinates, you enable them to do their jobs effectively" (Baldwin, 2012). It was also helpful during the meeting for the physician to periodically review the overall goals of the company. This would help to keep us focused on the important things, which sometimes could be forgotten in the daily rush of performing our jobs. We appreciated being filled in on changes and current events in the health care industry and having the chance to voice our opinions. We seemed to stay happier and more upbeat when we were communicating well and being considerate toward one another's needs and opinions. It was important to treat each other with respect and let each other have their turn to discuss issues that were important to them. Another internal factor that shaped our organization was how it was set up. Since we were a small company...
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